bluuebunny/crossref_metadata_2025 huggingface dataset:
MO880EFFECTIVENESS OF MEDIUM CUT-OFF VS HIGH FLUX DIALYZERS: A PROPENSITY SCORE MATCHING COHORT STUDY
Authors: Molano-Triviño Alejandra , Sanabria Mauricio , Vesga Jasmin , Buitrago Giancarlo , Sánchez Ricardo , Rivera Angela
Published: May 2021

Background and Aims

According to emerging evidence, medium cut-off membrane improves clearance of molecules larger than 25 kDa, including larger uremic toxins. There is growing evidence on clinical effectiveness outcomes associated with the use of these membranes.

Our aim was to evaluate clinical effectiveness of medium cut-off (HDx) versus high flux (HF-HD) dialyzers in terms of hospitalization rate and duration, cardiovascular event rate and survival in a HD prevalent cohort in Colombia through an observational, multicenter retrospective cohort analysis.

Method

Adult Prevalent HD patients (> 90 days in HD) at Baxter Renal Care Services Colombia were included between September 1st, 2017 to November 30th, 2017 (follow-up until 2 years). Socio-demographic and clinical characteristics of all patients were summarized descriptively. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on indicators of baseline socio-demographic and clinical characteristics. Weighted incidence rate ratios (IRRs) and rates and duration of hospitalization and cardiovascular events according to dialyzer type were obtained using binomial negative regression with the weighting sample.

Results

We evaluated 1098 patients (37.7% women): 534 in HF-HD vs 564 in HDx (Table 1), median age was 60.6 years. Mean time on HD was 5.6 years (SD 5.51) for HF-HD and 5.88 for HDX (SD 5.48)

We observed lower hospitalization rates in HDx group, (IRR HDx/HF-HD: 0.82 95% CI 0.69 to 0.98; p=0.03); and cardiovascular events rate, (IRR HDx/HF-HD: 0.65 95% CI 0.47 to 0.91; p=0.01) see Table 2. Main cause of hospitalization was cardio-cerebrovascular (Table 3). We observed no differences in hospitalization duration or survival.

Conclusion

We evaluated 1098 patients (37.7% women): 534 in HF-HD vs 564 in HDx (Table 1), median age was 60.6 years. Mean time on HD was 5.6 years (SD 5.51) for HF-HD and 5.88 for HDX (SD 5.48)

We observed lower hospitalization rates in HDx group, (IRR HDx/HF-HD: 0.82 95% CI 0.69 to 0.98; p=0.03); and cardiovascular events rate, (IRR HDx/HF-HD: 0.65 95% CI 0.47 to 0.91; p=0.01) see Table 2. Main cause of hospitalization was cardio-cerebrovascular (Table 3). We observed no differences in hospitalization duration or survival.
MO881LUNG ULTRASONOGRAPHY AND BIOIMPEDANCE IN ASSESSMENT OF VOLUME STATUS OF HEMODIALYSIS PATIENTS: A COMPARISON BETWEEN BOTH METHODS
Authors: Figueiredo Cátia , Roldão Marisa , Valerio Alves Ana Rita , Gonçalves Hernâni , Sofia Flora , Lopes Karina
Published: May 2021

Background and Aims

Assessment of volume status is an important prognostic factor in hemodialysis (HD) patients. Several methods have been suggested to estimate it: bioimpedance analysis, brain natriuretic peptide levels (BNP) and lung and inferior vena cava (IVC) ultrasonography (US), which are emerging as a valuable technique in this field. Our aim was to evaluate effectiveness of lung US in assessment of volume status in chronic HD patients and compare it with the gold standard bioimpedance technique.

Method

Cross-sectional study of 58 prevalent HD patients. Several analytical data were analyzed, including BNP, albumin and sodium levels. Lung and IVC US were performed to assess the presence and distribution of B-lines and the diameter and respiratory collapsibility of IVC, respectively. Fresenius® body composition monitor (BCM) was the bioimpedance technique used. It defines hyperhydration as relative fluid overload (RFO) >15%. Both US and BCM were performed at the same day, immediately before the middle week HD session. Categorical variables are presented as frequencies and percentages, continuous variables as means and standard deviations, or medians and interquartile ranges (IQR) for variables with skewed distributions. Statistical analysis was performed using SPSS® version 25 for Windows.

Results

The average age was 75.3±1.6 years and 56.9% were male. The average time in HD was 36.6±4.1 months. Half of the patients (n=29) presented B-lines in lung US. The diameter of IVC was significantly higher in this group of patients, both inhaling (1.3±0.4 vs 0.9±0.4; p=0.001) and exhaling (2.0±0.4 vs 1.6±0.5; p<0.001). Similarly, most patients with B-lines at lung US presented collapsibility of IVC < 50% (n=25; 89.3%).

Although not statistically significant, the RFO was higher in patients with presence of B-lines compared to those who did not present it (10.2±10.6% vs 5.4±6.9%; p=0.061). Considering the mean RFO value in patients with B-lines, we observed that its presence was significantly higher in patients with RFO > 10% compared to those with RFO < 10% (58.6% vs 31%; p=0.035). Besides, patients with RFO > 10% also presented higher BNP (9878±34646 pg/mL vs 3945±8634 pg/mL; p=0.009) and lower albumin levels (3.4±0.5 vs 3.7±0.4; p= 0.039) than other group.

Conclusion

Lung US seems to be a valuable tool to diagnose overhydration earlier than BCM, which currently defines hyperhydration as RFO >15%. In this study we verified that patients with lower levels of RFO (>10%) already presented signals of fluid overload, such as presence of B-lines at lung US, higher BNP and lower albumin levels. These findings support the benefit of lung US in guiding fluid removal and may change the practice in our HD unit to probe the ideal dry weight for chronic dialysis patients.
MO883FATIGUE IS THE PREDOMINANT PATIENT-REPORTED OUTCOME MEASURE IN HEMODIALYSIS PATIENTS: RESULTS OF A MULTICENTER CROSS-SECTIONAL EPROMS STUDY
Authors: Guerraoui Abdallah , Kolko-Labadens Anne , Prezelin-Reydit Mathilde , Chauveau Philippe , Lasseur Catherine , Lino-Daniel Marie , Haesebaert Julie , Cailette-beaudoin Agnes
Published: May 2021

Background and Aims

End Stage renal disease (ESRD) and hemodialysis are associated with a decrease in quality of life (QOL). Self-reported QOL symptoms are not always prioritized by the medical team, potentially leading to conflicting priorities with patients. Electronic patient-reported outcome measures (ePROMs) allow physicians to better describe these symptoms. The objective was to describe the prevalence of symptoms self-reported by HD patients.

Method

A multicenter cross-sectional study was conducted in three HD centers. Patients were included if they were 18 years old or over and treated with HD for at least three months in a center. Data were collected by the patient via a self-administered ePROMs questionnaire. Data included patient characteristics, post-dialysis fatigue and intensity, recovery time after a session, perceived stress, impaired sleep the day before the dialysis session, current state of health, and the one-year change.

Results

In total, we included 173 patients with a mean age of 66.2 years, a mean ± SD hemodialysis duration of 48.9 ± 58.02 months, mainly treated in self-dialysis unit (67%) and having at least one comorbidity (72.5%). The prevalence of fatigue was 72.1% [IC 95% 64.7% to 78.7%] with a mean severity score of 5.84± 2.12. 66.4% had a high level of stress (level B or C). Recovery time was more than 6 hours for 24.9% of patients and 78 % declared they had a better or unchanged health status than the previous year. The self-perceived health status of patients was 6.2± 2.12 and 77.5% [IC 95% 70.5% to 83.5%] of patients stated that they had not a worsened health status than the year before. No statistical differences were observed between centers for the PROMS. Despite significant differences in patient characteristics from the three centers including age, comorbidities or type of dialysis, no differences were found on the prevalence of the various PROMs, in favor of internally

Conclusion

Fatigue and stress were the main symptoms reported by HD patients. There was no association between symptoms reported and comorbidities clinical results of patients. The patient’s care teams should better consider these symptoms.
MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS
Authors: Than Win Hlaing , Ng Jack K C , Chan Gordon C K , Fung Winston , Szeto Cheuk Chun
Published: May 2021

Background and Aims

The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD.

Method

We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed.

Results

The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival.

Conclusion

Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.
MO705SLEEP DISTRUBANCES IN PATIENTS ON PERITONEAL DIALYSIS
Authors: Rihem Dahmane , Hanen Chaker , Salma Toumi , Olfa Zini , Fatma Mseddi , Khawla Kammoun , Soumaya Yaich , Mohamed Ben Hmida
Published: May 2021

Background and Aims

Sleep disturbances are more common in patients with chronic renal failure and on dialysis than in the general population. They affect their mental health and quality of life. The objective of this study was to evaluate the sleep disorders of patients on peritoneal dialysis (PD).

Method

We report the results of a descriptive cross-sectional study in 27 patients on PD in order to assess the quality of sleep in these patients and its relation with mental health and quality of life. Sleep quality was performed using the Pittsburgh Sleep Quality Index (PSQI) to assess origin and extent of sleep disorders. Anxiety-depressive disorders were assessed using the HAD (Hospital anxiety and depression) scale. The quality of life (QOL) measurement was performed by the SF36 and KDQoL.

Results

We included 15 men and 12 women with an average age of 45.74 years (21–77). Eleven patients were on automated peritoneal dialysis (APD) and 16 patients on continuous ambulatory peritoneal dialysis (CAPD). The mean duration of dialysis was 45.77 ± 25 months. Poor quality of sleep was reported in 14 patients. The mean PSQI was 7.22 ± 4.87. The most affected components were sleep duration and usual sleep efficiency. Depression was objectified in 22.22% of patients and 26% of patients had anxiety.

Impaired quality of sleep was associated with decreased quality of life. The components of the physical dimension of quality of life: limitation due to physical condition, physical pain were significantly lower in dialysis patients with good quality of sleep (p=0.014, p= 0.033 respectively)

The mental dimension component of QOL of SF36: relationship to others, limitation due to mental condition was also lower in patients with sleep disturbances (p=0.039, p= 0.036 respectively).

Symptoms and problems, as well as the effects and the burden of kidney disease were not associated with poor quality of sleep. Impaired sleep quality was also not significantly associated with depression or anxiety in our series.

Conclusion

Sleep disturbances are common in PD patients and are associated with decreased quality of life. Therefore, they must be taken into account in the therapeutic measures recommended in order to improve the quality of life of these patients and reduce morbidity and mortality.
MO708INCREASE IN PERITONEAL DIALYSIS-RELATED HOSPITALIZATION RATES DURING COVID-19 PANDEMIC
Authors: Calice-Siva Viviane , Ferreira Helen , Sevignani Gabriela , Vieira Marcos , Vodianitskaia Raíssa , Nerbass Fabiana
Published: May 2021

Background and Aims

In March 2020 to reduce the coronavirus spread in Brazil professional regulatory agencies allowed the telemedicine for distance patients’ monitoring. All peritoneal dialysis (PD) patients from our center previously followed monthly in face-to-face visits were monitored by telephone call appointments since then. In this study, we aimed to investigate and compare the hospitalization rates before and during the telehealth assistance.

Method

Patients aged 18 years and older in March 2020 were included. We analysed total hospitalization rate and PD-related hospitalization rate (infectious, mechanical dysfunction and hypervolemia) 6-month before (first phase) and 6-month after (second phase) telehealth implementation.

Results

A total of 117 patients were included (male: 45%; age: 56.9 ± 16.2 years old; PD vintage: 15 (7–26) months; automated PD: 97%; diabetes: 45%). There were 15 hospital admissions in 13 patients (2 patients were admitted twice) during the first phase, resulting in an incident rate (IR)=23 per 1000 patients-month. In the second phase, the numbers increased to 34 admissions (3 due to covid-19) in 30 patients (1 patient admitted twice and another four times), IR=56 per 1000 patients-month. The total hospitalization incident rate ratio (IRR) was 2.43 (CI 95% 1.32 – 4.48). The total PD-related hospitalization increased from 4 (3 hypervolemia, 1 mechanical) to 20 (12 infectious, 3 mechanical; 5 hypervolemia) episodes during telehealth assistance, representing 26% to 59% of total hospitalizations. IRR for PD-related hospitalization was 5.5 (CI 95% 1.8 – 16.4).

Conclusion

After telehealth implementation, the risk of hospitalization raised significantly, mainly due to PD-relates causes that increased 5.5 times. Potential causes of this finding are lack of proper training for distance monitoring to patients and health care workers, life habits and routine of care modifications and social isolation. More studies are needed to assess the independent impact of telehealth on PD patients outcomes.
MO712EVALUATION OF VOLUME OVERLOAD STATUS MARKERS IN PERITONEAL DIALYSIS PATIENTS
Authors: Carvão João , Fernandes Adriana , Veríssimo Rita , Calça Rita , Martins Ana Rita , Matias Patricia , Branco Patricia
Published: May 2021

Background and Aims

N-terminal fragment of B-type natriuretic peptide (NT-proBNP) can reflect changes in hydration status and may help the nephrologist to estimate it. Fluid volume overload is a major concern in dialysis patients, and it is associated with increased cardiovascular risk and death. This study evaluated the relationship between serum NT-proBNP levels and left ventricular (LV) dysfunction and extra-cellular excess water in peritoneal dialysis patients.

Method

We conducted a cross-sectional study of 60 peritoneal dialysis (PD) patients. Incident and prevalent patients were included. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also analysed.

Results

A total of 60 patients were evaluated (male 60% (n=36), mean age was 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2 and 31.7% (n=19) had diabetes mellitus (DM). Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum NT-proBNP level was 1071 pg/mL. LV mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L.

Serum NT-proBNP levels correlated positively with, diabetes (r=0.27, p=0.04), isquemic cardiopathy (r=0.37, p=0.01), LV mass index (r=0.48, p=0.001) and extracellular water (r=0.31, p=0.02) and negatively with LV ejection fraction (r= -0.81, p=0.01). In a multivariable analysis, in a model adjusted to time in DP, diabetes, residual diuresis, isquemic cardiopathy and left ventricle mass index, NT-proBNP > 1600 pg/mL was associated with patient overhidratation (exp (B) 1,44, 95% CI 0,15-2.73).

No statistical difference was observed considering nutritional parameters, peritoneal transport, dialysis efficacy and NT-proBNP.

Conclusion

In this population, higher levels of NT-proBNP were associated with overhydration status and left ventricular dysfunction. Therefore, BIA and NT-proBNP may be complementary to clinical evaluation of PD patients. BIA results can be affected by malnutrition with loss of cell mass according to some studies. In our population NT-proBNP is not affected by nutritional status and therefore can also be used as a congestive marker in malnourished patients. Longitudinal application of BIA could be a useful clinical tool to evaluate adequacy in PD patients.
MO713ENCAPSULATING PERITONEAL SCLEROSIS IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Ouertani Imen , Awatef Azzabi , Wissal Sahtout , Narjes Ben Aicha , Sanda Mrabet , Sabri Ferdawes , Dorsaf Zellema , Yosra Guedri , Achour Abdelatif
Published: May 2021

Background and Aims

Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD). Causative factors are the chronic exposure to bioincompatible PD and peritonitis episodes. Pro-inflammatory state and oxidative stress associated with chronic uremia may further accelerate these pathomechanisms. Clinical symptoms are, essentially, signs of intestinal obstruction. Treatments commonly used are corticosteroids, tamoxifen, immunosuppressants like azathioprine, mycophenolate mofetil (MMF), or mTOR inhibitors which has fibrinolytic properties and may help with reducing inflammation. In the last ten years, the incidence of SEP in kidney transplant recipients has increased, but few cases have been reported. Given the rare nature of this pathology, we decided to publish the cases of two EPS happening after kidney transplantation (KT).

Case report

We report the cases of two male patients aged 46 and 25 with a history of chronic renal failure, who benefited of continuous ambulatory peritoneal dialysis (CAPD) for three years. The first patient was switched to haemodialysis (HD) for sub-dialysis, with one episode of peritonitis and one episode of catheter infection. The second patient had three episodes of peritonitis complicated by asymptomatic EPS, hence its transfer to HD. Our two patients presented, at 30 and 40 days post KT, an episode of acute intestinal obstruction with abdominal scans fitting with a mechanical bowel obstruction on an encapsulating peritonitis without signs of complication. Both patients were on corticosteroid therapy (15 and 17.5 mg/day) combined with MMF and Calcineurin inhibitors (CNIs) (Tacrolimus). Medical measures were not effecient. Surgical treatment was then considered. During the operation, a classical picture of EPS was found characterized by a thin cocoon-like sclerotic membrane encasing the small bowel. A complete resection of the encapsulating sclerotic membrane and total adhesiolysis were performed, with an immediate improvement on the clinical level. No recurrence was noted for both patients at 5 and 24 months respectively.

Conclusion

The specificities of our patients compared to the reported cases were the short duration of the PD and the relatively young age. In fact, some studies demonstrated an increased incidence of EPS in younger patients. In addition, this complication has declared itself despite corticosteroid therapy. Some case reports have demonstrated an increase in the incidence of SEP in kidney transplant patients, suggesting the possible implication of CNIs which have a profibrotic effect and may promote peritoneal matrix accumulation.
MO714MEAN PLATELET VOLUME / PLATELET COUNT RATIO IN PERITONEAL DIALYSIS: ASSOCIATION TO PERITONEAL TRANSPORT STATUS
Authors: Zeiler Matthias , Federico Antonio , Monteburini Tania , Santarelli Stefano
Published: May 2021

Background and Aims

Mean platelet volume volume (MPV) is gaining scientific interest with regard to cardiovascular risk stratification. The MPV/platelet count ratio seems to be more specific than mean platelet volume alone as a surrogate parameter for platelet activation. The MPV/platelet ratio might be of interest in peritoneal dialysis (PD) as the distribution and integrity of endothelial – platelet interaction in the abdominal space determines its function. The aim of the study was to evaluate the associations between MPV/platelet ratio and peritoneal transport status.

Method

In 123 PD patients (median age 65 years) MPV and platelet count were measured together with anthropometric patient data and peritoneal function at catheter placement and after 6 months during the first peritoneal equilibration test (PET). MPV and platelet count were determined with a fully-automated hematological analyzer. Correlation analysis was performed.

Results

The MPV/platelet ratio decreased significantly from 3.99% at placement to 3.50% at the first PET (median values, Wilcoxon test p<0.001). Neither anthropometric data, nor creatinine clearance, nor BUN clearance, nor Kt/V (renal, peritoneal, total), nor erythrocyte sedimentation rate, nor C reactive protein were associated to MPV/platelet ratio. Only D/P urea and D/P creatinine were significantly correlated to MPV/platelet ratio (D/P urea r=0.223, p=0.01; D/P creatinine r=0.199, p=0.03). Slow transporters presented a significantly lower MPV/platelet ratio than average transporters (median values, 3.49% versus 3.83%, Mann-Whitney test p=0.03).

Conclusion

Peritoneal dialysis is reducing significantly the MPV/platelet ratio. Differences in MPV/platelet ratio are reflected in the peritoneal transport status at 6 months after dialysis start. The reduction of the MPV/platelet ratio might respect a reduced platelet and endothelial activation even in the abdominal space.
MO715PROFILE OF INFECTIVE ENDOCARDITIS IN HEMODIALYSIS PATIENTS
Authors: Badrouchi Samarra , Mariem Hajji , Barbouch Samia , Ben Hmida Fethi , Amel Harzallah , Ben abdallah Taieb
Published: May 2021

Background and Aims

Infectious complications are the second leading cause of death in hemodialysis patients. This population is particularly exposed to bacteremia, on the one hand, because of the vascular access necessary for hemodialysis, which is a gateway to the various micro-organisms, and on the other hand, factors of susceptibility to infections. Infective endocarditis (IE) is the cardiac endothelium infection associated with bacteremia. It is a rare complication but its mortality remains high especially in patients on chronic hemodialysis.

The aim of this study was to determine the microbiological profile, clinical and-biological profile, characteristics in the ultrasound, therapeutic modalities, and prognosis of IE in hemodialysis.

Method

This is a retrospective descriptive study of including chronic hemodialysis patients, admitted in the Nephrology and Internal Medicine Department A of the Charles Nicolle Hospital in Tunis for an IE during the period from 1973 to 2018. We used the modified Duke criteria to confirm the diagnosis of IE.

Results

Nineteen patients were included, including 12 men and 7 women (gender ratio=1.7). The average age was 49.1 years [29-66 years]. Seven of them (37%) were known to have a valvular disease, two of them had a double mitro-aortic valve replacement. Six of them (32%) were diabetic and two patients (11%) were on immunosuppressive therapy. The vascular access initially used for HD were arteriovenous fistula in 9 cases (47%), internal jugular catheter in 3 cases (16%), subclavian catheter in 1 case (5%), Canaud catheter in 3 cases (16%), and 2 patients were dialyzed by femoral catheter (11%). Clinically, all patients had an altered general condition, fever was present in 14 cases (74%) and a heart murmur in 10 cases (53%). Blood cultures were positive in 14 cases (74%). The isolated germs were Staphylococcus Aureus in 8 cases, Staphylococcus epidermidis in 4 cases, Pseudomonas aerogenosa in 3 cases, Enterobacterium in 1 case, enterococcus faecalis in 1 case, and Klebsielle oxytoca in one patient. On cardiac ultrasound, mitral valve damage was found in 10 patients, aortic sigmoid in 4 patients and tricuspid valve in 3 patients. The treatment included appropriate antibiotic therapy in all cases and a valvuloplasty was indicated in 7 patients. Nine patients (47%) died during their hospitalization.

Conclusion

Hemodialysis patients are particularly exposed to IE. The most appropriate preventive method is the strict observance of asepsis when handling the vascular access first and the rapid eradication of all infectious outbreaks.
MO716THE RELATIONSHIP BETWEEN LYMPHOCYTE SUBSETS, NUTRITIONAL STATUS AND TUBERCULIN REACTIVITY IN CONTINUOUS AMBULATORY PERITONEL DIALYSIS AND HEMODIALYSIS PATIENTS
Authors: Usta Mehmet , Ersoy Alpaslan , Ayar Yavuz , Budak Ferrah
Published: May 2021

Background and Aims

Skin test anergy is common in patients with uremia and during maintenance hemodialysis treatment. However, up to date only one study concerning skin test in peritoneal dialysis patients has focused on the issue. Our cross-sectional controlled study was conducted to analyze the correlation of purifed protein derivative (PPD) test response with demographical features, nutritional parameters and the distribution of peripheral blood lymphocyte subsets in peritoneal dialysis and hemodialysis patients.

Method

Stable 30 hemodialysis (HD) patients (16 men, 14 women) and 30 continuous ambulatory peritoneal dialysis (PD) patients (17 men, 13 women) were included. Thirty healthy cases (15 men, 15 women) with a mean age of 32.4±9.4 constituted the control group.

Results

In the HD group, 14 patients (46.6%) were PPD positive, and ın the PD group 16 patients (53.3%) were PPD positive. In the PPD-positive HD patients 64.2% (9/14), and in the PPD-positive PD patients 62.4% (10/16) had an induration of 10 mm or greater. In the control group, 21 of 30 patients (70%) were PPD positive. Comparison of both HD and PD groups with the control group showed signifcant diferences in PPD reactivity (p<0.01). Albumin levels were signifcantly high in the control groups (p<0.01), and cholesterol levels were signifcantly high in the PD and the control groups (p<0.05). Transferrin levels were signifcantly high in the PD (p<0.01). The lymphocyte counts were signifcantly high in the control group compared to the HD patients (p<0.05). The lymphocyte subset percentages CD19 were high in the control groups (p<0.05), and CD16/56 was signifcantly high in the PD groups (p<0.05). All the parameters were also similar between PPD-positive and -negative same groups.

Conclusion

The prevalence of PPD positivity was lower in the PD and HD groups. The PPD test responses were not related to the peripheral lymphocyte counts, subsets and malnutrition parameters.
MO719PERITONEAL DIALYSIS IN ELDERLY PATIENTS
Authors: Achouch Sonia , Barbouch Samia , Hajji Meriam , Cherni Nadia , Ounissi Mondher , Gorsane Imen , Hedri Hafedh , Goucha Rim , Ben Abdallah Taieb , Amel Harzallah , Ben Hmida Fethi
Published: May 2021

Background and Aims

Peritoneal Dialysis (PD) is now often being initiated in older patients. The benefits of this modality of dialysis have been well demonstrated in the literature. The aim of our study was to analyse the epidemiological and clinical profile of the elderly patients and to determine predictive factors of mortality

Method

It was a retrospective study including 51 case defined as patients ≥65-year-old, treated by PD in the Internal Medicine Department of the Charles Nicolle hospital during the period between 1986 and 2020.

Results

Fifty one patients were enrolled in the study. Their mean age was 71,6 ± 5,4 years [65 - 86]. There were 32 men (62, 7%) and 19 women (37,2%) . The method of initiation was the PD in 53, 84%. Diabetic and vascular nephropathy was the first cause of End-Stage Renal Disease in 56% and 19,6%. The mean Charlson score was 5,5 ± 1,4 [3-9]. The mean age when using PD was 70.8 ± 6 years [54-86]. Autonomous and active patients were detected in 29.4%. Diabetes mellitus, hypertension and coronary artery disease was observed in 58,8%, 29,4% and 15.7% of patients. In our study, 82.35% started on automated PD (APD) and 17,6% on continuous ambulatory PD (CAPD). The rate of mortality was 53%.

Switching modality from PD to hemodialysis occurred in 29,4% of cases. A univariate logistic regression identified a coronary artery disease as significantly associated with increased mortality (HR=2,1 [1-2,1, IC 95%](p=0.035)).

Conclusion

Elderly patients on dialysis face many issues but can have continued success with PD when they have adequate care and support. The control of the morbidities such as coronary artery disease is important to decrease the rate of mortality in patients using this modality of dialysis.
MO686THE EFFECT OF A CONTINUOUS TRAINING PROGRAM ON PERITONEAL DIALYSIS PATIENTS' SURVIVAL
Authors: Theodoridis Marios , Bezirgianidou Stamatia , Serif-Damadoglou Humeyra , Kantartzi Konstantia , Passadakis Ploumis , Thodis Elias , Panagoutsos Stylianos
Published: May 2021

Background and Aims

Peritoneal Dialysis (PD) is a well-established method for dialysis of end stage kidney disease patients. Peritoneal membrane alters with time from several causes such as bioincompatible PD solutions, uremia, and the cumulative effect of peritonitis episodes. Each center follows a specific training program to prevent the appearance of peritonitis episodes. The aim of this study was to retrospectively evaluate the influence of proper and continuous training on the mortality of peritoneal dialysis patients.

Method

This is a single center retrospective study of 133 PD patients conducted for the time period 2009 – 2019 (10 years). The training course was taught one-on-one, nurse-to-patient at the initiation of dialysis and then once every 6 months at their regular visit or sooner if there was a peritonitis episode. The program included a rated questioner based on the Canadian Association of Nephrology Nurses for Nursing Standards and Practice Recommendations published on August 2008. The patients were divided into two groups according to the mean value (34) of their questioner sum (QS). Group A included 69 patients with mean age of 66 ± 15 years (36 M, 33 F) with mean PD duration of 45 ± 30 months and they achieved a score less than 34. Group B included 64 patients with mean age of 61 ± 18 years (42 M, 22 F) with mean PD duration of 62± 32 months and they achieved a score greater than 34. The cumulative all-cause survival of the PD patients was calculated by Kaplan Meier, was compared using Long Rang analysis and was also adjusted for their age, gender, the modality of PD applied, the presence of Diabetes and their level of education. Using Cox Regression, we tried to find independent risk factors such as the score they achieved in the questioner. The two groups were compared also for their overhydration and their frequency appearance of peritonitis or exit site infection.

Results

The cumulative survival using Kaplan-Meier analysis revealed statistically significant deference between the two groups (Log Rank p<0.001) with Group B (QS>34) achieving better survival. When the survival was adjusted for age, sex, Diabetes, PD modality the result remains the same. Trying to find among the total of our patients the possible risk factors for mortality, using Cox Regression analysis, their QS score (representing their training level for PD) was statistically significant (HR 0,931 {0.892, 0.971}, p=0.001) independent risk factor, as well as age and PD modality, for our patient survival. Additionally, Group B (QS>34) had statistically significant a smaller number of peritonitis episodes (p<0.001) and presence of peripheral edema (p<0.001).

Conclusion

In our study we concluded that continuous and monitored training of peritoneal dialysis patients has a significant effect on their survival and the frequency of peritonitis appearance.
MO687FREE WATER TRANSPORT AND ABSOLUTE DIP OF DIALYSATE SODIUM CONCENTRATION: EARLY CLINICAL PARAMETERS FOR PERITONEAL FIBROSIS IN PD PATIENTS?
Authors: Roldão Marisa , Escoli Rachele , Gonçalves Hernâni , Ferrer Francisco , Lopes Karina
Published: May 2021

Background and Aims

Reduction of peritoneal salt and water removal is an important cause of shortened patient and technique survival in peritoneal dialysis (PD). The aim of this study was to longitudinally analyze changes in fluid and solute transport parameters in PD patients during the first year of treatment, using peritoneal equilibration test (PET).

Method

Retrospective observational study of incident PD patients who underwent 4-hour 3.86% glucose PET with additional measurement of ultrafiltration at 1 hour, 1 month after PD initiation and 12 months later. Parameters of peritoneal transport such as dialysate-to-plasma ratio of creatinine (D/Pcreat), ultrafiltration at 1 and 4 hours, small-pore ultrafiltration (SPUF), free water transport (FWT), sodium removal and absolute dip of dialysate sodium concentration (ΔDNa) at 1 hour (as an expression of sodium sieving), were calculated. Serum cancer antigen 125 (CA-125) was also assessed. Clinical, analytical and demographic data were analyzed. Statistical analysis was performed using SPSS (Version 23 for Mac OSX).

Results

The average age of 16 incident PD patients was 58.69 ± 8.51 years, 10 (62.5%) were male and 5 (31.8%) were diabetic. Ten patients (62.5%) were on automated peritoneal dialysis (APD). One month after PD initiation, membrane characteristics were: D/P = 0.684 ± 0.589, total UF at 4h = 0.696 ± 0.283L, UF at 1h = 0.487 ± 0.162L, SPUF = 0.303 ± 0.359L, FWT = 0.207 ± 0.738L, %FWT = 51.855 ± 11.828%, sodium removal = 38.048 ± 16.087mmol/L and ΔDNa = 11.125 ± 3.34mmol/L. Average serum CA-125 was 51.206 ± 22.6U/mL. A paired sample t-test was performed to compare these parameters 1 and 12 months after PD initiation and revealed a statistically significant increase of 0.11± 0.196L (p=0.042) on SPUF and 18.607 ± 7.1mmol/L (p=0.019) on sodium removal. ΔDNa showed a decrease of 2.5 ± 0.743mmol/L (p=0.005) and % FWT of 11.782 ± 12.831% (p=0.002). FWT also showed a decrease of 0.168 ± 0.019L, total UF at 4h of 0.206 ± 0.142L and UF at 1h of 0.114 ± 0.243L, however did not reach statistical significance. D/Pcreat remained stable. CA-125 showed a mild decrease of 3.644 ± 22.364U/mL although not statistically significant. Pearson correlation revealed a positive correlation between the variation of total UF at 4h and the variation of FWT (r=0.553, p=0.026) and ΔDNa (r=0.503, p=0.047), but not with SPUF, sodium removal, D/Pcreat or CA-125, during the study follow-up period.

Conclusion

The reduction of FWT through aquaporins and, particularly, the reduction of ΔDNa as a sodium sieving measure, appear to be the first functional changes in peritoneal membrane, suggesting that fibrosis may begin soon after PD initiation. Our results indicate that FWT and ΔDNa can be used to access fibrotic peritoneal alterations earlier than other conventional parameters such as D/Pcreat.
MO910CHANGE IN BODY COMPOSITION MEASURED BY BIOIMPEDANCE SPECTROSCOPY AFTER COVID19 LOCKDOWN IN HAEMODIALYSIS PATIENTS
Authors: Aubert Lucia , Fernandez-Vidal María , Caro Espada Paula Jara , Afonso Sara , Sandino Pérez Justo , Mérida Evangelina , Gutiérrez Elena , Yuste Claudia
Published: May 2021

Background and Aims

Changes on body composition have an impact on the survival of haemodialysis (HD) patients. The aim of the study was to determine the impact of the reduction of physical activity due to COVID19 lockdown on body composition in HD patients.

Method

Retrospective and observational study including 149 HD patients. Nutritional and Bioimpedance spectroscopy (BIS) data were recorded before and after COVID19 lockdown (mean of 148 ± 20 days between determinations).

Results

Over the 49 days of COVID19 lockdown, we observed a decrease in normohydrated weight (NHW) of 1.01 ± 3.59 kg mainly secondary to a reduction on total body water (TBW) 0.95 ± 3.78 L (extracellular water 0.45 ± 1.58 L and intracellular water 0.41 ± 2.36 L). There was also a small loss on lean tissue index (LTI) of 0.28 ± 2.42 kg/m2, with an increase of fat tissue index (FTI) 0f 0.02 ± 2.82 kg/m2. Twenty-three patients presented COVID19 infection, of which 21 required admission (median of 10 [4-16] days). Patients who presented COVID19 were older (70.7 ± 12.0 vs 64.9 ± 16.6 years, NS) with higher Charlson index (7.48 ± 2.77 vs 6.33 ± 2.65, p = 0.07). Patients with COVID19 infection presented a greater loss on LTI (-1.18 ± 3.15 bs -0.16 ± 2.30 kg/m2; p = 0.22), FTI (-0.41 ± 3.38 vs 0.06 ± 2.74 kg/m2; p = 0.54); BMI (-1.49 ± 2.14 vs -0.25 ± 0.96 kg/m2; p = < 0.01) and NHW (-4.00 ± 6.33 vs -0.62 ± 2.90 kg; p = < 0.01) compared to patients without COVID19 infection. The length of hospitalization was associated with greater loss of BMI and NHW, resulting, therefore, in overhydration. There also had lower serum phosphorus (3.6 ± 0.8 vs 5.2 ± 0.8 mg/dl; p = 0.01) and serum albumin (3.5 ± 0.4 vs 4.0 ± 0.1 g/dl; p = 0.01). Seven patients died during hospitalization. Deceased patients were older (78.4 ± 6.6 vs 67.4 ± 12.4 years; p = 0.01), presented higher comorbidity (estimated by Charlson index 10.0 [8.0-11.0] vs 6.5 [4.3-8.0]; p = 0.02) and were more overhydrated (3.4 ± 3.6 vs 1.9 ± 1.9; p = 0.34). Although not statistically different, they had lower LTI (10.4 ± 2.1 vs 12.0 ± 3.4 kg/m2; p = 0.18) and lower serum albumin (3.4 ± 0.6 vs 3.9 ± 0.4 g/dl; p = 0.08) compared to survivors. Patients who survived COVID19 infection had longer hospitalization (57% were discharged between twelfth and forty third day; mean hospitalization 14.6 ± 11.5 days). Deceased patients died within the first 12 days of hospitalization (6.8 ± 4.1 days).

Conclusion

COVID19 lockdown induced a weight reduction on HD patients due to decrease in total body water. COVID19 infection increased this reduction, inducing greater loss on lean and fat tissue composition. Moreover, COVID19 impact on body composition was magnified with the length of hospitalization.
MO911ALTERED CIRCULATING OMENTIN-1 LEVELS REFLECT IRON DEFICIENCY IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Bolignano Davide , Presta Pierangela , Crugliano Giuseppina , Greco Marta , Dragone Francesco , Foti Daniela , Andreucci Michele , Coppolino Giuseppe
Published: May 2021

Background and Aims

Iron deficiency is pervasive among hemodialysis (HD) patients; however, although transferrin saturation (TSAT) of <20% and/or serum ferritin of <200 ng/mL should express iron scarcity, in HD patients high ferritin levels could be related to inflammation rather than reflecting optimal iron stores. Omentin-1 is an anti-inflammatory adipokine that is also involved in regulation of iron metabolism through binding with lactoferrin. In this pilot study, we aimed at evaluating serum levels of Omentin-1 in a small HD population, in order to determine its possible relationships with iron status.

Method

Omentin-1 was measured by ELISA in serum samples of 33 chronic HD patients before a single mid-week HD session and at 1h, 2h and 3h after dialysis start. Common biochemical and clinical parameters were also recorded.

Results

Serum omentin-1 levels were statistically higher in HD patients than in matched healthy controls (763 [367-1423] vs. 371 [228-868] ng/mL; p=0.03). Omentin-1 levels were broken down after the first hour of HD (reduction ratio: 45±5%) and tended to get back to baseline after the third hour (p=0.04). Correlation analyses showed omentin-1 levels to be directly associated with serum iron (R=0.380; p=0.03), ferritin (R=0.843; p<0.001), TSAT (R=0.661; p<0.001), serum amylase (R=0.454; p=0.01), ALT (R=0.380; p=0.03) and inversely with serum phosphate (R=-0.403; p=0.02), troponin (R=-0.443; p=0.01) and transferrin (R=-0.390;p=0.04). At ROC analyses, Omentin-1 levels showed a remarkable capacity to discriminate HD patients with iron deficiency (TSAT<20%) with an AUC of 0.830 (95%CI 0.658 to 1.000; p=0.002. best cut-off value: ≤478.8 ng/mL; sens. 75%; spec. 85%). Of note, such discriminatory capacity was even better than that of serum ferritin (AUC 0.739; 95%CI 0.528 to 0.950; p for differences between AUCs=0.04; Figure 1)

Conclusion

Findings from this pilot study demonstrate that HD patients have altered Omentin-1 values probably because this protein is involved in the maintenance of iron equilibrium. Larger studies are needed to confirm whether Omentin-1 might be proposed as a new tool in the assessment of iron deficiency and in the management of iron therapy for HD patients.
MO913BODY COMPOSITION EVALUATED BY BIOIMPEDANCE IN FRAIL PATIENTS ON HEMODIALYSIS
Authors: Álvarez López Álvaro , Cancho Castellano Barbara , López Arnaldo Cristina , Diaz Campillejo Rosa Maria , Garcia de Vinuesa Palo Elena , Aragón Lara Rafael , Rodriguez Sabillon Jorge Alberto , Valladares Alcobendas Julián , Cerezo Arias Isis , Martín Hidalgo Barquero María Victoria , Ruiz Calero Cendrero Rosa María , Robles Perez-Monteoliva Nicolas-Roberto
Published: May 2021

Background and Aims

Frailty is known as a biological syndrome of decreased reserves and resistance to stress, with a decline of multiple physiological systems, causing vulnerability. Its prevalence ranges from 10-80 %. The etiopathogenesis is multifactorial, based on the loss of muscle mass associated with aging or sarcopenia. Chronic Kidney Disease (CKD) is a model of accelerated aging, with impaired physical function, frailty and cognitive decline.

The main theorical frameworks on frailty are the one advocated by Linda Fried, in which she develops a phenotype as a risk situation for developing disability and one advocated by Kennet Rockwood which establishes that frailty consists of addition of various health conditions including comorbidity and disability. Our objective was to evaluate frailty in stage 5 CKD in haemodialysis, measured by clinical scale and to relate it to the body composition measured by bioimpedance.

Method

Cross-sectional study in 40 subjects with CKD in hospital haemodialysis, 70.5±13.03 years, 62.5% male. 40% Diabetic Nephropathy, 10% Glomerulopathies, 7.5% Nephroangiosclerosis, 2.5% Chronic Tubule-Interstitial Nephropathies, 32.5% Unknow, 2.5% Others. 35% arteriovenous fistula, 10% arteriovenous graft, 55% central venous catheter. Hemodialysis type: 40% High Flux, 45% Online postdilutional Haemodiafiltration, 10% Acetate Free Biofiltration. Fragility was measured by the Rockwood clinical scale: not fragile (1-4), moderately fragile (5-6) and severely fragile (7-9). Body composition was estimated by monofrequency bioimpedance measurement. Chi-Cuadrado was used to study differences between dichotomous variables and ANOVA for continuous variables. Spearman correlation´s was used to examinate the intensity of association between two quantitative variables. Statistical analysis was performed with SPSS 13.0.

Results

42.5% of the subjects presented a degree of fragility ≥5, severely fragile 27.5%.

The results are shown in the Tables 1 and 2.

Conclusion

The degree of frailty is greater in the elderly. Measurement of body composition by bioimpedance can be useful to indirectly asses frailty. The phase angle could be an indicator of fragility, since in more fragile subjects its value decreases, its physiological role remains to be elucidated. There is a positive trend to an increase in extracellular water in more fragile subjects, keeping the subjects in their dry weight, so it will be necessary to evaluate what is due.
MO905EFFECTS OF DIFFERENT DIALYSIS TECHNIQUES ON INFLAMMATION IN MAINTENANCE HEMODIALYSIS PATIENTS WITH COVID-19: A RANDOMIZED STUDY
Authors: Esposito Pasquale , Cipriani Leda , Verzola Daniela , Grignano Maria Antonietta , Grosjean Fabrizio , Russo Elisa , Rampino Teresa , Viazzi Francesca
Published: May 2021

Background and Aims

Uncontrolled inflammation plays a relevant role in the pathogenesis of Coronavirus Disease-19 (COVID-19) and has been related to disease severity and unfavorable outcomes. Here, we studied the time trend of pro-and anti-inflammatory markers in a population of patients undergoing hemodialysis (HD) affected by COVID-19, evaluating the potential modulating effects of two different dialysis approaches.

Method

For this prospective randomized study, we recruited maintenance hemodialysis patients with confirmed COVID-19 infection. After diagnosis, the patients were randomized to two different dialysis modalities, expanded HD (HDx), performed by use of a medium cut-off membrane, and standard treatment based on the use of a protein-leaking dialyzer (PLD). Clinical and laboratory data were collected, including circulating pre and post-dialysis levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-g). Samples were collected at diagnosis (T0), one and two weeks after the diagnosis (T7 and T14, respectively).

Results

Twenty-seven HD patients with COVID-19 (69.7 ±16.6 years, 14 males) were compared with 14 non-infected HD patients, as the control group. COVID-19 patients presented a significantly reduced number of lymphocytes, including CD4 andCD8 subpopulations, and higher levels of ferritin and lactate dehydrogenase. Moreover, COVID-19 patients had higher levels of IL-6 [35.5 (59.4) vs 12 (43) pg/ml, p=0.048] and IL-10 [9.3 (20.8) vs 1.2 (1.4) pg/ml, p=0.02], while the levels of IL-8 and sTLR4 were comparable. Then, twenty-five patients were randomized to undergo HDx (n.15) or PLD (n.10).

Basal characteristics and cytokine levels were not significantly different between the two groups. All over the study, no significant modifications of circulating cytokine levels were observed. Similarly, no significant differences were found between patients on HDx or PLD evaluated at different time points. After a single HD treatment, IL-8 showed a significant reduction compared to pre-dialysis levels in both groups. IL-8 reduction rate resulted significantly correlated with IL-8 pre-dialysis levels. Finally, there were no correlations between cytokine levels and clinical characteristics and outcomes.

Conclusion

In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Modulation of the inflammation is not a suitable therapeutic target in this specific population. Other mechanisms could be involved in the pathogenesis of COVID-19 in HD patients.