bluuebunny/crossref_metadata_2025 huggingface dataset:
MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY
Authors: Abdellatif Tarek , Hamad Abdullah , Alkadi Mohamad , Abuhelaiqa Essa , Othman Muftah , Ibrahim Rania , Akl Tabaseem , Yasin Fadumo , Aly Sahar , Eljaali Musab , Almalki Hassan
Published: May 2021

Background and Aims

Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay.

Method

This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7.

Results

There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7.

Conclusion

This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.
MO859TRANSITIONS BETWEEN THE DIFFERENT DIALYSIS MODALITIES AND THEIR EFFECT ON SURVIVALS: A SINGLE-CENTER STUDY
Authors: Kurylovich Krystsina , Komissarov Kirill
Published: May 2021

Background and Aims

An integrated care approach available today, which implies that most patients will use different modalities at different time points of their disease, creates a need to accumulate data on patient outcomes and survival when switching from one treatment modality to another. The aim was to compare survival after the transition from hemodialysis (HD) to continuous ambulatory peritoneal dialysis (CAPD) and after the transfer from CAPD to HD.

Method

A single-center retrospective trial included 20 (18.9%) from 106 initiating CAPD between January 2016 and December 2020 patients, who were transferred from CAPD to HD or from HD to CAPD through a follow-up period until December 2020. 2 groups of patients were identified: the 1st group included CAPD-to-HD transition patients, the 2d group - HD-to-CAPD transition patients. At the end of a follow-up, the transfer's causes, outcomes, and cohort life expectancy (CLE) on the new treatment modality were evaluated.

Results

A summary of patients' characteristics are shown in the table below. The patient's number in the 1st group was 13, in the 2d - 7. Transfer causes in the 1st group were peritonitis (76.9%), leakage (15.4%), in the 2d group - vascular access problems (57.1%), poor hemodialysis tolerance (28.6%). In both groups in 1 case transfer cause was the patient's preference (7.7% and 14.3% respectively). In the 1st group CAPD duration was 29 [13;50] months, transfer outcomes included death in 7 cases (53.8%), renal transplantation (RT) in 2 cases (15.4%), in 2 cases (15.4%) patients were alive and were on HD, in 2 cases (15.4%) patients later were transferred back to CAPD. In the 2d group HD duration was 23 [3;30] months, transfer outcomes included death in 2 cases (28.6%), RT in 2 cases (28.6%), in 3 cases (42.8%) patients were alive and on CAPD. In the 1st group in 6 from 7 cases (85.7%) patients died in the intensive care unit (ICU), the main causes of death included cardiovascular accidents - 42.8% (cardiac arrest, acute heart failure, stroke), sepsis - 28.6% (due to gallbladder empyema and diabetic foot sepsis), bleeding - 28.6% (due to essential thrombocythemia, undiagnosed peptic ulcer). In the 2d group all patients died at home, causes of death involved congestive heart failure - 50% and uremia - 50.0%. In the 1st group CLE was 3.4 months, in the 2d - 20.5 months.

Conclusion

Post-transfer mortality is higher in the CAPD-HD transition group. In most cases, such patients die faster and in more severe condition and almost always in the ICU. Almost half of the CAPD-to-HD transfer patients died due to cardiovascular complications. Therefore, when transferring a patient to HD, it is necessary to take into account the load exerted on the heart and blood vessels, as well as the risks of bleeding and sepsis.
MO861THE PROGNOSIS OF PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) AFTER CARDIOVASCULAR SURGERY DEPENDS ON THE INDICATION FOR ITS INITIATION
Authors: Schizas Nikolaos , Smyrli Maria , Dedeilia Aikaterini , Patris Vasilios , Samiotis Ilias , Dedeilias Panagiotis , Argiriou Michail
Published: May 2021

Background and Aims

Continuous Renal Replacement Therapy is required in 2.6% to 5% of patients who have undergone cardiovascular surgery. Although its implementation is frequent, several aspects of this therapeutic measure still remain uncertain.

Method

The data of all patients who were surgically treated during a 3-year period (2017-2019) at a single cardiovascular department were collected and the cases in which continuous renal replacement therapy was used were identified. From this group, the data of those that received dialysis for the first time were analyzed.

Results

In about 5% of patients renal replacement was inevitable, and the mortality rate among them reached 57.6%. The mean duration of renal therapy was 8.4 days. The investigation of laboratory parameters in different stages revealed certain aspects about the expected outcomes. The survival rate varied significantly in relation to the indication for CRRT. Fluid overload and electrolytic disorders were associated with high survival rate, while oliguria or anuria, acidosis or intoxications were linked to increased mortality rate.

Conclusion

Despite CRRT being associated with high mortality rates, it is the only option for life-threatening conditions in clinical practice. The indication for CRRT is a key factor for the prognosis, decision-making and the overall management of a patient.
MO867THE SIGNIFICANCE OF THE MEAN PLATELET VOLUME AS A BIOMARKER IN HEMODIALYSIS PATIENTS
Authors: Al-Sayyari Abdulla
Published: May 2021

Background and Aims

The mean platelet volume was found to be an important biomarker in certain medical conditions. We evaluate its significance in patients on chronic hemodialysis

Method

Adult stable patients on chronic hemodialysis for at least six months were included. MPV together with certain demographic ( age, sex, BMI, dialysis vintage, cause of CKD, medication taken, mode of dialysis, type of vascular access) and laboratory parameters (Hb, albumin, Kt/V, PTH, CRP serum lipids) were measured and recorded

The correlation between these parameters and MPV was evaluated using Pearson correlation coefficient and the MPV in the absence or presence of the demographic parameters was calculated independent t test

Results

One hundred and twenty- three patients were studied. The mean age was 60.0± 18.4 and 48.7% were male and diabetes was the cause of CKD in 56.3% ; 72.6% were on hemodialysis and 27.4% on hemodiafiltration , 52.1% used AV fistula and 47.9% used permcath as vascular access; 50.9% were on aspirin Comparing the mean MPV above and below the 50th percentiles in different parameters revealed no significant differences. No significant correlation was found between MPV and duration on dialysis, age, weight, BM, erythropoietin dose per week, PTH, hemoglobin, albumin, CRP, number of admissions in the preceding year yea, LDL or HDL. However , there was a mild positive correlation with triglyceride level (Pearson coefficient = 0.2 (P=0.02).

Conclusion

No significant correlation or association was found between the MPV and any of the clinical demographic or laboratory parameter measured except that there was a mild positive correlation with triglyceride level.
MO814RISK PREDICTION OF COVID-19 INCIDENCE AND MORTALITY IN A LARGE MULTI-NATIONAL HAEMODIALYSIS COHORT: IMPLICATIONS FOR MANAGEMENT IN OUTPATIENT SETTINGS
Authors: Haarhaus Mathias , Santos Carla , Haase Michael , Mota Veiga Pedro , Lucas Carlos , Macário Fernando
Published: May 2021

Background and Aims

Experiences from the first wave of the 2019 coronavirus disease (COVID-19) pandemic can aide in the development of future preventive strategies. To date, risk prediction models for COVID-19-related incidence and outcomes in haemodialysis (HD) patients are missing.

Method

We developed risk prediction models for COVID-19 incidence and mortality among HD patients. We studied 38 256 HD patients from a multi-national dialysis cohort between March 3rd and July 3rd 2020. Risk prediction models were developed and validated, based on predictors readily available in outpatient haemodialysis units. We compared mortality among patients with and without COVID-19, matched for age, sex, and diabetes.

Results

During the observational period, 1 259 patients (3.3%) acquired COVID-19. Of these, 62% were hospitalised or died. Mortality was 22% among COVID-19 patients with odds ratios 219.8 (95% CI 80.6-359) to 342.7 (95% CI 60.6-13595.1), compared to matched patients without COVID-19. Since the first wave of the pandemic affected mostly European countries during the study, the risk prediction model for incidence of COVID-19 was developed and validated in European patients only (N=22 826, AUCDev 0.64, AUCVal 0.69). The model for prediction of mortality was developed in all COVID-19 patients (AUCDev 0.71, AUCVal 0.78). Angiotensin receptor blockers were independently associated with a lower incidence of COVID-19 in European patients.

Conclusion

We identified modifiable risk factors for COVID-19 incidence and outcome in HD patients. Our risk prediction tools can be readily applied in clinical practice. The current study can aid in the development of preventive strategies for future waves of COVID-19.
MO874COVID-19 IN HEMODIALYSIS PATIENTS: CLINICAL PARTICULARITIES AND OUTCOMES
Authors: Abid Hanen , Toumi Salma , Zini Olfa , Sai Amira , Agrebi Ikram , Dammak Najla , Chaker Hanen , Masmoudi Mondher , Kammoun Khaoula , Yaich Soumaya , Ben Hmida Mohamed
Published: May 2021

Background and Aims

Coronavirus disease 2019 (COVID-19) has affected the care and outcomes of patients treated with dialysis worldwide. Patients on hemodialysis (HD) are at extremely high risk to develop COVID-19 because of their multiple co-morbidities and immunosuppression.

We report throw this work the experience of our unit of HD with the covid-19 infection and its outcomes on our patients.

Method

We conducted a prospective study since the beginning of the pandemic. We have collected 26 HD patients reached of COVID 19 disease.

Results

The sex ratio of our population was equal to 1,36 with female predominance. The mean age of our patients was 61, 31 ±14,17 years. The co-morbidities noted among these patients were respectively hypertension, diabetes, heart diseases and obesity in 19, 17, 10 and 10 cases. The causal nephropathy was respectively diabetic, undetermined, glomerular and interstitial nephropathy in 13, 9, 2 and 2 cases. The major symptoms associated to the COVID 19 were respectively dyspnea, cough, asthenia, fever and chills, digestive manifestations, chest pain in 22, 19, 19, 15, 10, and 6 cases. 7 patients have been exposed to covid-19 infested person. Symptoms appeared within an average of 4,3 ± 2 days. Oxygen saturation was less than 92% in 65% of the cases during hospitalization. 84% of the patients are hospitalized including one among them who required the stay in a resuscitation unit and intubation. The scannographic lesions of covid were estimated to more than 50% in 8 cases and less than 50% in 4 cases. A biological inflammatory syndrome has been noted in all of the patients with a mean CRP at 117+/-127 mg/l and the mean leucocytes count at 10248±6592 elt/mm3. Lymphopenia was noted in 14 cases with lymphocytes count less than 1500 elt/mm3. The ratio of neutrophils / lymphocytes was more than 2,5 in 12 cases. The treatment was based on oxygen, corticosteroids, antibiotics, vitamins and anticoagulation for hospitalized patients (22 patients). The mean number of HD sessions realized per patient during hospitalization was 4 ± 2,3 HD sessions. The perdialytic complications noted were alteration of the state of consciousness in 3 cases and heart failure in 5 cases. The outcomes of our patients were marked by death in 38% and a recovery in 62% of the patients. Thus, the forms observed in our series are respectively moderate, severe, pauci-symptomatic and asymptomatic in 12, 10, 2 and 2 cases.

Conclusion

We highlight throw this study the severe consequences of COVID-19 on HD patients in whom mortality reached 38%. Until the pandemic is controlled and a vaccine or a treatment are valid, we highlight the importance of the compliance with confinement and develop home dialysis among our population.
MO875SEROCONVERSION RATE AND PERSISTANCE OF IGG RESPONSE TO SARS-COV2 IN HEMODIALYSIS PATIENTS. A CASE SERIES STUDY
Authors: Tsikliras Nikolaos , Anagnostara Aggelina , Rekari Vasiliki , Nikitidis Ilias , Kyrgialanis Apostolos
Published: May 2021

Background and Aims

Higher incidence and worse outcome of coronavirus disease (COVID-19) are observed in dialysis patients, mainly due to weak immune response. However, little is known about seroconversion ability and duration of antibody response after COVID-19 in this group. The aim of this study was to estimate the seroconversion rate and the persistence of IgG response to SARS-CoV2 in dialysis patients.

Method

Four (4) dialysis patients previously infected with SARS-CoV2 were included in this study. Initially, all patients were tested for the presence of IgG antibodies 21-35 days after the onset of their symptoms. The cut-off value for positivity was a ratio of ≥ 1.4. Those patients with at least two consecutive positive samples were defined as seropositives. Seropositives were then having their antibodies tested monthly for a maximum period of six months or until the first negative result. Duration of antibody persistence was defined as the time between the day IgG were last detected and the day of onset of infection.

Results

All four patients were seropositives after the initial test (seroconversion rate = 100%) with a mean IgG ratio of 6.44 (±1.28). Median follow up period was 128 (range 96-193) days. Median duration of antibody persistence was 153 (range 103-193) days. By the sixth month, IgG had turned negative in two of four patients (rate = 50%).

Conclusion

In our study, dialysis patients showed a remarkable seroconversion rate after infection with SARS-CoV2. However, a rapid decline of IgG antibodies was observed in half of them.
MO670EXPANDED HEMODIALYSIS REDUCES THE CONCENTRATION OF FREE LIGHT CHAINS IN PATIENTS WITH ACUTE KIDNEY INJURY IN MYELOMA CAST NEPHROPATHY
Authors: Vishnevskii Konstantin , Domashenko Olga
Published: May 2021

Background and Aims

The myeloma cast nephropathy is largely associated with the production of intact immunoglobulin and free light chains (FLC) by a plasma cells monoclone. The use of high-flux hemodiafiltration (HDF) contributes to a decrease in the concentration of FLC. However, it is not always possible to achieve the required substitute volume with acute kidney injury (AKI) emergency treatment. An alternative to HDF could be the usage of membranes with a medium cut-off (expanded hemodialysis (HD), Expanded HD). The aim of this study was to compare the degree of reduction in FLC concentration using conventional HD, HDF and Expanded HD.

Method

The study includes patients with newly diagnosed multiple myeloma who presented indications for HD therapy start. Procedures were performed on a daily basis from the moment when indications for HD therapy were identified. The duration of the first three procedures was 2 hours. Consistently for each patient the first procedure was carried out using a standard low-flow filter, the second - using a high-flow dialyzer and HDF (substitute volume 9 liters for 2 hours), the third - using a Theranova 400 filter (Baxter, Germany). The concentrations of FLC (kappa and lambda) and albumin were determined every 30 minutes of each treatment. Chemotherapy was prescribed according to the local clinical recommendations in combination with the ongoing renal replacement therapy.

Results

The study included 7 patients with cast nephropathy, mean age 68±8 years. Average concentration before treatment: kappa FLC 876±727 μg/ml (norm 3.25-15.81 μg/ml), lambda FLK 84±112 μg/ml (norm 3.23-28.05 μg/ml), albumin 34±1 g/l (norm 40-50 g/l). After 2 hours of treatment, there was a decrease in kappa FLC concentration with HDF (-34±33%, p=0.01) and with Expanded HD (-31±12%, p<0.001), but not with conventional HD (-1±7, p=0.79, Fig 1). The lambda FLC concentration also decreased with HDF (-41±29%, p=0.01) and with Expanded HD (-28±22%, p=0.01), but not with conventional HD (-3±12, p=0.65, Fig 2). Albumin concentrations did not change significantly with any of the treatments.

Conclusion

Expanded HD, as well as high-flow HDF, helps to reduce the FLC concentration in patients with cast nephropathy without loss of albumin, which may have a positive effect on the multiple myeloma prognosis. Further studies are needed regarding possibilities of using Expanded HD in the complex therapy for patients with AKI in myeloma cast nephropathy.
MO676COMPLEMENT ACTIVATION BY DIALYSIS MEMBRANES AND ITS ASSOCIATION WITH SECONDARY MEMBRANE FORMATION AND SURFACE CHARGE
Authors: Melchior Pascal , Erlenkötter Ansgar , Zawada Adam , Delinski Dirk , Schall Christian , Stauss-Grabo Manuela , Kennedy James
Published: May 2021

Background and Aims

Activation of the complement system may occur during blood-membrane interactions in hemodialysis and contribute to chronic inflammation of patients with end-stage renal disease (ESRD). Hydrophilic modification with polyvinylpyrrolidone (PVP) has been suggested to increase the biocompatibility profile of dialysis membranes. In the present study we compared complement activation of synthetic and cellulose-based membranes, including the polysulfone membrane with α-tocopherol-stabilized, PVP-enriched inner surface of the novel FX CorAL dialyzer, and linked the results to their physical characteristics.

Method

Eight synthetic and cellulose-based dialyzers (FX CorAL, FX CorDiax [Fresenius Medical Care]; Polyflux, THERANOVA [Baxter]; ELISIO, SUREFLUX [Nipro]; xevonta [B. Braun]; FDX [Nikkisio Medical]) were investigated in the present study. Complement activation (C3a, C5a, sC5b-9) was evaluated in a 3h ex vivo recirculation model with human blood. Albumin sieving coefficients were determined over a 4h ex vivo recirculation model with human plasma as a surrogate of secondary membrane formation. Zeta potential was measured as an indicator for the surface charge of the membranes.

Results

The FX CorAL dialyzer induced the lowest activation of the three complement factors (C3a: -39.4%; C5a: -57.5%; sC5b-9: -58.9% compared to the reference). Highest complement activation was found for the cellulose-based SUREFLUX (C3a: +154.0%) and the FDX (C5a: +335.0%; sC5b-9: +287.9%) dialyzers. Moreover, the FX CorAL dialyzer had the nearest-to-neutral zeta potential (-2.38 mV) and the lowest albumin sieving coefficient decrease over time. Albumin sieving coefficient decrease was associated with complement activation by the investigated dialyzers.

Conclusion

Our present results indicate that the surface modification implemented in the FX CorAL dialyzer reduces secondary membrane formation and improves the biocompatibility profile. Further clinical studies are needed to investigate whether these observations will result in a lower inflammatory burden of hemodialysis patients.
MO678DISTRIBUTION OF PERIPHERAL BLOOD T CELL SUBTYPES IN HEMODIALYSIS PATIENTS TREATED WITH MEDIUM CUT-OFF MEMBRANES AND HIGH-FLUX MEMBRANES
Authors: Hasbal Nuri Baris , Sevinç Mustafa , Yilmaz Vuslat , Basturk Taner , Ahbap Dal Elbis , Sakaci Tamer , Ozcafer Perin Nazif , Lindholm Bengt , Unsal Abdulkadir
Published: May 2021

Background and Aims

Mortality in end stage renal disease is higher than in the general population. In addition, there is also an increase in mortality that cannot be explained by known risk factors. In this context, researchers have been determining on these additional risk factors for years. Although inflammation is a proven risk factor, further studies are still needed. In this study, we aimed to investigate the effect of membranes on the distribution of T cell subgroups in peripheral blood mononuclear cells (PBMC) that play an important role in inflammation.

Method

Twenty-five patients were enrolled in the study, and patients received hemodialysis treatment first with MCO membrane (MCO) for 3 months and then with high-flux membrane (HF) for another 3 months. Peripheral blood samples were taken from the patients just before the hemodialysis procedure at 0 (starting with MCO), 3rd (switching to HF) and 6th (end of study) months. PBMC’s were separated by ficoll density gradient centrifugation and stored in liquid nitrogen. Frozen cells were stained with fluorescently labeled monoclonal antibodies and were utilized with flow cytometry device. Data were analyzed using FlowJo7.6.5 programs.

Results

Proportions of helper T (CD3+CD4+), cytotoxic T (CD3+CD8+), and follicular helper T (CD3+CD4+ CXCR3-CXCR5+) cells were similar in both membranes. The use of MCO decreased the ratios of peripheral CD3+T (p=0.07) and Th1 (CD3+CD4+CXCR3+CCR6+) (p<0.0001) cells while increasing the ratio of NK cells (p=0.03). In addition, the shift of the immune balance towards an increase in Th17 (CD3+CD4+CXCR3-CCR6+) (p=0.005) and Th2 (CD3+CD4+CXCR3-CCR6-) (p <0.0001) cell ratios with HF.

Conclusion

: The results can be interpreted as the prevention of a Th1 dominant inflammation seen with HF. Therefore, it suggests that the use of MCO may reduce T cell based inflammation in peripheral blood.
MO659INITIAL EXPERIENCE OF PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION
Authors: Balta Lamprini , Kitrou Panos , Georgopoulou Georgia Andriana , Papasotiriou Marios , Papachristou Evangelos , Karnabatidis Dimitrios
Published: May 2021

Background

Arteriovenous fistulas (AVFs) for hemodialysis are inconstantly used primarily due to problems with maturation and early thrombosis. An endovascular approach -without open surgery- for fistula creation offers another option for establishing a reliable vascular access. By this procedure, a arteriovenous fistula is created in the area of the cubital fossa in the deep vascular system, either between the ulnar artery and the accompanying vein or the radial artery and radial vein and uses the perforating vein at the level of the elbow to transfer blood to the superficial network of the arm.

Aim

To evaluate the safety, success and maturation rates of percutaneous arteriovenous fistula creation.

Materials and Methods

From February 2018 to June 2020 (28 months), 30 percutaneous arteriovenous fistulas (pAVF) using the WavelinQ device were created in 30 patients (male: 100%) with end stage kidney disease. Outcome measures were safety, defined as adverse events occurring within the first month of creation, success, defined as the ability to create an anastomosis between the vessels of interest and maturation rates, defined as the ability to perform at least one successful dialysis with the AVF. Secondary outcome measures included procedural complications, secondary procedures, time to cannulation, and AVF survival.

Results

All cases were performed as day procedures. 23 out of 30 patients (70%) were already on hemodialysis carrying a permanent central venous catheter. Main comorbidities were hypertension (21/30; 70%), diabetes (15/30; 50%) while 11/30 (30.5%) were smokers. Success was 100% (30/30). Mean follow-up was 547 days (range: 14-1071 days). In one case a pseudoaneurysm of the brachial artery was created immediately after sheath removal and in another case, an aneurysm of the AVF anastomosis was observed 17 days post-procedure and AVF was legated with a covered stent placed in the arterial part. In all, 26/30 AVFs (86.6%) were successfully cannulated. Mean time to cannulation was 61.3 days. Another one failed after maturation during the follow-up period. In total, 15 interventions were needed to achieve maturation (15/26; 0.58 procedures per AVF). 5 maintenance endovascular interventions were performed during the follow-up period (5/26; 19.2%). Mean time from cannulation to the end of follow up was 566.2 days (range: 135-1041 days).

Conclusion

Current analysis suggests that percutaneous AVF creation is safe, successfully performed with high maturation rates. Large scale prospective studies are needed to validate results.
MO662EFFECT OF ARTERIOVENOUS VASCULAR ACCESS ON BIOIMPEDANCE MEASUREMENTS IN HEMODIALYSIS PATIENTS
Authors: Wang Lin-Chun , Zhu Fansan , Thwin Ohnmar , Preciado Rojas Priscila , Rosales Merlo Laura , Tao Xia , Thijssen Stephan , Kotanko Peter
Published: May 2021

Background and Aims

Fluid management remains a major problem in hemodialysis (HD) patients, partly because of the lack of objective assessment methods. Many methods have been proposed to estimate the fluid status in HD patients and bioimpedance has established as one of the most popular clinical tools. Resistance to alternate current was found to be lower in the arteriovenous (AV) access-bearing side compared with the non-access side in post-HD bioimpedance measurements. We hypothesized this difference between access and non-access sides can be seen in both pre- and post-HD measurements of arms and whole body. The aim of the study was to investigate whether this variation between access and non-access sides could affect single-side whole body measurements.

Method

Pre- and post-HD bioimpedance measurements with two 8-point devices (InBody 770 and Seca mBCA 514) were performed in 11 HD patients with functioning AV access in the arm (8 male, pre-HD 75.4 ± 13.6 kg, post-HD 72.8 ± 13.5 kg). Values of resistance at 5 kHz (R5) in the arm and whole body (R5 of arm + trunk + leg on the same side) were extracted. Whole-body extracellular water (ECW) was calculated using whole-body R5 by the Xitron equation* to evaluate how measuring only one side of the body can affect the fluid volume calculation.

Results

The R5 of the arm on the access side was lower compared with the non-access side both pre- and post-HD (P < 0.01), measured by InBody. The same was seen with the Seca but did not reach statistical significance (Table 1). The estimated whole-body ECW was higher on the access side for InBody (P < 0.01). With Seca, the same trend was seen but remained non-significant. While the difference in ECW between both arms reported by InBody was small, the impact on calculated whole-body ECW was much larger with a difference between sides of 0.50 ± 0.82 L pre HD and 0.55 ± 0.81 L post HD.

Conclusion

InBody appears to pick up the difference in fluid status between the access and non-access side with greater precision than Seca. The large contribution of the arm to whole-body resistance amplifies the impact of the presence of an AV access on whole-body ECW estimations based on single-side wrist-to-ankle bioimpedance measurements. Eight-point bioimpedance devices (like the tested InBody and Seca) measure both sides of the body, so, choice of measurement side does not enter the picture.
MO894EVALUATIONS OF TOXIC HEAVY METALS LEAD AND MERCURY IN REGULAR HEMODIALYSIS SMOKER AND NONSMOKER PATIENTS BY COMPARISON WITH OTHER HEALTHY CONTROL SUBJECTS IN EGYPTIAN POPULATION
Authors: Shalaby Ezzeldin , Abdelmawgoud Hisham
Published: May 2021

Background and Aims

Around worldwide population, 10% are affected by chronic kidney diseases (CKD); hemodialysis is the common choice of renal replacement therapy. Cigarette smokers have higher Lead level than non-smoker population. As Tobacco leaves are grown on polluted soil, it is proven that Mercury poisoning depends on dose and duration of exposure. Aim of the study was to determine two important toxic heavy metals elements Lead and Mercury concentrations in regular hemodialysis patients smoker and non-smoker by comparison with normal subjects and its correlation to anemia.

Method

Blood samples were collected from CKD patients on maintenance hemodialysis for more than 6 months divided into non-smoker and smoker to be compared with samples from a control group of non-CKD, non-smoker persons. This study was conducted in September 2019 in Al Mokattam Insurance Hospital – Cairo and involved 60 persons of both sex. They were divided into 3 groups: CKD stage 5 patients on hemodialysis 40 patients and sub-divided into 2 groups; (smoker) 20 patients and (non-smoker) 20 patients and the history of eating fish and seafood was taken. The third group was a control group included 20 healthy non-smoker participants. Lead and Mercury were analyzed by electro thermal atomic absorption spectrophotometer in Al Borg central Laboratory. The complete blood count (CBC), kidney function tests and Iron parameters were also detected.

Results

duration on hemodialysis did not raise Lead or Mercury level in blood, while smoking raises Lead level in blood, and eating fish and sea food more than once per week increased Mercury level in blood. There was a relation between raised Lead level and anaemia in hemodialysis patients.

Conclusion

Lead Prolonged and Mercury measurement is important in hemodialysis patients with possible symptoms of heavy metal toxicity. Lead level monitoring is recommended in resistant anemia in hemodialysis patients.
MO895EVOLUTION AND PROGNOSIS OF HEMODYALISIS PATIENTS WITH MODERATE AND SEVERE COVID INFECTION: SINGLE HOSPITAL CENTRE EXPERIENCE
Authors: Pana Camelia , Iordache Alexandru , Bogdan Campineanu , Sburlan (Stanigut) Alina Mihaela , Tuta Liliana-Ana
Published: May 2021

Background and Aims

One of the major challenges of our century seems to be the SARS-COV2 virus pandemic that has resulted, at least until now, in over 2 million deaths worldwide. Multiple observational studies showed that patients with chronic kidney disease and especially those on the hemodialysis program have an increased risk of severe morbidity and mortality caused by the novel coronavirus.

Aim of study

was to determine the prognosis and mortality risk in hemodialysis patients hospitalized for symptomatic COVID-19 infection, using the ALAMA age score and the COVID-GRAM critical illness risk score.

Method

Prospective and retrospective study that included 74 patients undergoing chronic hemodialysis, hospitalized in the Constanta County Emergency Clinical Hospital between March 2020 - December 2020, confirmed with SARS-CoV 2 infection by RT-PCR testing.

Results

Out of the total number of 74 hospitalized patients (64.58% M, 35.41% F; mean age = 66.64 years), having moderate and severe forms of the disease. 56.25% needed conventional oxygen therapy, 22.9% non-invasive mechanical ventilation and 12.5% intubation and ventilation. All patients underwent specific treatment according to the national protocols, updated with the rapid changes and increasing informations regarding the disease management. The mean duration of hospitalization was 12.33 days. 94.7 % of patients had additional risk factors (diabetes mellitus-47.56%, arterial hypertension-87.3%, COPD – 7.8%, systemic aterosclerosis – 35.4%, immunosuppression – 11.6%, malignant tumors – 4.8% ). Mean ALAMA score was more than 85 years (p<0.01) and mean COVID-GRAM critical illness risk score was 202 (92.1% risk for critical illness). Fatal outcome affected 37.8% of the patients, mainly due to severe respiratory failure, myocarditis, arrhythmias and stroke.

Conclusion

Hemodialysis patients with SARS-CoV 2 infection have an unfavorable evolution and a reserved prognosis with a high risk of death, depending especially on the need for ventilatory support. 6.25% of the patients followed had post-COVID syndrome (disseminated intravascular coagulation, severe bacterial infections, enterocolitis), but these long-term complications of the survivors will need further studies.
MO897ANXIETY AND DEPRESSIVE DISORDERS IN CHRONIC HEMODIALYSIS PATIENTS
Authors: Ezzaki Sanae , Failal Imane , Elafifi Rania , Elkhayat Salma , Elmedkouri Ghizlane , Ramdani Benyounes
Published: May 2021

Background and Aims

Hemodialysis is experienced as a vital need and is a heavy strain that is causing psychological distress expressed by anxiety and depression. The aim of our study was to estimate the prevalence of anxiety and depression in chronic hemodialysis patients.

Method

This is an observational cross-sectional study, carried out within the unit CASABLANCA CHU ibnrochd of hemodialysis in January of 2020 of 71 chronic hemodialysis patients, in collaboration with a psychiatrist, the scale of anxiety and depression (HAD) has been used to diagnose and assess the severity of anxiety and depression in this population.

Results

Our study included 71 chronic hemodialysis adult patients, the average age of our patients was 46.5 years, ranging from 16 to 93 years, with a sex ratio M / F 1.1, seniority average hemodialysis is 17.3 years; patients are single, married, widowed, divorced in 66%, 26%, 5% and 3% of cases, 72.5% of our patients are without profession.

None of the patients is followed by a psychiatrist or under antidepressant or anxiolytic during the study, 46% of our patients have anxiety and depression with a male predominance in 56% of cases, anxiety was found in 15% of patients, 1 case of major anxiety, the average score of anxiety is 10 ± 2, depression was found in 36% of cases and 1 case of major depression, the average depression score was 11 ± 2.

Conclusion

Anxiety and depression are common in patients on periodic hemodialysisThese results emphasizes the importance of collaboration between nephrologists and psychiatrists in order to offer hemodialysis patients psychological support and guarantee a better quality of life.
MO879PROPOSAL OF A GERIATRIC ASSESSMENT TAILORED FOR OLDER CHRONIC KIDNEY DISEASE PATIENTS: RESULTS OF A PRAGMATIC CONSENSUS-BASED APPROACH
Authors: Voorend Carlijn , Joosten Hanneke , Berkhout-Byrne Noeleen , Diepenbroek Adry , Franssen Casper , Bos Willem Jan W , Van Buren Marjolijn , Mooijaart Simon
Published: May 2021

Background and Aims

Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced kidney disease. Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, for older people with advanced chronic kidney disease.

Method

A pragmatic approach was chosen to reach agreement on a suitable set of instruments to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This approach included focus group meetings to identify criteria for the assessment, literature review to identify potential instruments, questionnaire to inventory currently used instruments, an expert consensus meeting to ensure that the selection of tests was based on input from clinical experience in nephrology and geriatrics, and pilot testing to ensure practicability. In preparation of the consensus meeting we composed a project team and an expert panel (n=33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the test-set.

Results

Selection criteria related to general geriatric domains, clinical relevance, feasibility and duration of the assessment. The consensus-set contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains (Figure 1). Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 minutes, respectively. Results are discussed in a multi-disciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions and follow-up interventions amongst which comprehensive geriatric assessment.

Conclusion

This first multi-disciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced chronic kidney disease. The proposed geriatric assessment is currently implemented in multiple hospitals and studies. Future initiatives and studies should provide insights on effectiveness, feasibility, patient’s satisfaction and, value for shared treatment decision making and outcome improvement.
MO692COULD THE RESIDUAL RENAL FUNCTION REMAIN A KEY DETERMINANT OF PLASMA OXALIC ACID CONCENTRATION IN PERITONEAL DIALYSIS PATIENTS?
Authors: Stepanova Natalia , Korol Lesya , Snisar Lyudmyla , Lebid Larysa
Published: May 2021

Background and Aims

Under physiological conditions, the bulk of circulating oxalate (90% to 95%) is ultimately excreted by the kidneys. Under uremic and/or anuric conditions, dialysis is considered to be the main method of oxalate removal. Nevertheless, little evidence is available on oxalate balance in peritoneal dialysis (PD) patients. The present study aimed to evaluate the separate contribution of residual renal and peritoneal oxalate clearances to oxalate balance in PD patients.

Method

We performed a cross-sectional observational study involving 62 PD patients with the average age of 50.5±13.5 years and PD vintage of 37±24 months. Plasma oxalate (POx) concentration, levels of daily urinary (UOx) and peritoneal dialysis effluent oxalate (PDEOx) excretion were evaluated. POx concentration was measured spectrophotometrically using MAK315 kit (Sigma, Spain); UOx and PDEOx concentrations were determined using an oxalate oxidase/peroxidase reagent (BioSystems, Spain). In addition, oxalate transport status (4-hour D/P oxalate ratio), renal oxalate clearance (ROxCL) and peritoneal oxalate clearance (PerOxCL) were calculated.

Results

Among the examined PD patients were 41 (66%) patients with preserved diuresis and 21 (34%) patients with anuria. The anuric PD patients had lower PerOxCL and, accordingly, peritoneal and overall oxalate removal levels compared with the patients with preserved diuresis (Table 1).

Conclusion

The results of our research demonstrated an important role of the residual renal function in oxalate balance in PD patients. However, the decline in RRF could partially (but not completely) contribute to the increase in POx in PD patients. Thus, PerOxCL but not ROxCL could significantly affect oxalate balance in PD patients.
MO698IS PERITONEAL DIALYSIS SUITABLE METHOD FOR OBESE PATIENTS?
Authors: Damjanovic Tatjana , Bjedov Jelena , Maslarevic Radovic Vesna , Stopić Bojan , Rajcic Tatjana , Manasic Mirjana , Naumovic Radomir , Dimkovic Nada
Published: May 2021

Background and Aims

In recent years, obesity has reached epidemic proportions, and it's a great challenge to choose an adequate treatment for obese ESRD patients. The aim of the study was to analyze the outcome in patients with peritoneal dialysis with different degrees of nutrition expressed through body mass index at the beginning of treatment.

Method

The prospective clinical study included 53 incidental patients, who started peritoneal dialysis between June 2006 and August 2015. According to BMI on the beginning of treatment, patients were divided into three groups: normal weight: BMI of 18.5 - 24.9 kg/m2, n=17, overweight: BMI of 25 - 29.9 kg/m2, n=25, obese: BMI> 30.0 kg/m2. n=11. Mechanical and infective complications, technique survival and patients survival were analyzed over 48 - months period.

Results

In terms of mechanical complications, there was no difference between the groups- malposition of the catheter (p = 0.769), leakage of dialysate (p = 0.462), hernia (p = 0.381). Exit sitе infection were most prevalent in group 3 - 1 episode/22 patient months vs 1 episode/30 patient months in groups 1 and 2, but without statistical significance (p = 0.272). However, the lowest incidence of peritonitis was in the group 3 - 1 episode/40 patient months vs 1 episode/30 patient months in group 2, and 1 episode/33 patient months in group 1, but even here the difference did not reach statistical significance (p = 0.624). Cardiovascular events – myocardial infarction, stroke and peripheral vascular disease were rare in all groups, with no statistical significance between groups. The incidence of hospitalizations was highest in the obese group – 1 episode/22 patient months vs 1 episode/27 patient months in group 2, and 1 episode/25 patient months in group 1 (p = 0.735). Kaplan Meier's analysis showed the worst, but not significant, survival of the technique in a group of obese patients (group 1 vs. group 2; p = 0.536; group 1 vs. group 3 - p= 0.662; group 2 vs. group 3 - p = 0.357). Also, overall patient survival was not differed between the groups (group 1 vs group 2 - p = 0.387; group 1 vs group 3 - p= 0.885; group 2 vs group 3 - p = 0.375). According to Cox's analysis, only values of total cholesterol at the end of the follow-up period (p = 0.027) and diastolic blood pressure (p = 0.013) were significantly associated with overall survival obese patients.

Conclusion

In the present study the degree of nutrition at the beginning of treatment had no significant effect on the outcome of peritoneal dialysis treatment. Therefore, patients should not be discouraged for peritoneal dialysis on the basis of BMI.
MO700EPIDEMIOLOGICAL ADMISSIONS IN PERITONEAL DIALYSIS IN A SINGLE DIALYSIS CENTER
Authors: Panuccio Vincenzo Antonio , Lucisano Silvia , Tripepi Rocco , Tripepi Giovanni Luigi , Mallamaci Francesca
Published: May 2021

Background and Aims

The knowledge of the impact of peritoneal dialysis (PD) program in terms of hospitalization rate can provide solid guidance for nephrologists for management purpose. In a historical cohort of adult PD patients, we examined the hospitalization rates and causes of hospital admissions.

Method

One hundred ninety-one consecutive PD patients between January 1st 2000 to December 31st 2018 were enrolled. The maximum follow up was 194 months. Their mean age was 65±15 years, 110 were males, 56 had co-morbidities and 67 were diabetics. The median PD vintage was 35 months (interquartile range 20-63 months).

Results

During the follow-up, 163 out of 191 patients (85%) underwent hospital admission for a total of 356 hospitalizations [57 hospitalizations per 100-person-years]. The most frequent cause of admission was infection (20 hospitalizations per 100-person-years) mainly due to peritonitis (12 hospitalizations per 100-person-years) followed by cardiovascular diseases (17 hospitalizations per 100-person-years). Hospitalizations due to miscellaneous causes were 21 per 100-person-years. In the whole group, high NYHA score [Incidence Rate Ratio (IRR): 1.52, 95%CI 1.21-1.89, P<0.001], residual diuresis <500 ml/die (IRR: 1.43, 95%CI 1.13-1.82, P=0.002), malnutrition (IRR: 1.47, 95%CI 1.08-1.99, P=0.01) and older age (>65 years) (IRR 1.26, 95%CI 1.02-1.56, P=0.03) and were associated to all-cause hospitalizations. In an analysis by hospitalization type, the factors related to admission for infection diseases was malnutrition (IRR: 1.91, 95%CI 1.16-3.03, P=0.005) and high NYHA score (IRR: 1.52, 95%CI 1.03-2.22, P=0.02). As expected, hospitalizations due to cardiovascular causes were strongly related to older age (>65 years) (IRR 2.02, 95%CI 1.35-3.03, P<0.001), diabetes (IRR 2.13, 95%CI 1.43-3.18, P<0.001), high NYHA score (IR 2.14, 95%CI 1.43-3.21, P=0.001], residual diuresis <500 ml/die (IRR: 1.65, 95%CI 1.06-2.55, P=0.02) and previous cardiovascular events (IRR: 1.50, 95%CI 0.98-2.25, P=0.05).

Conclusion

Analyzing the causes and the rate of hospitalization in PD patients allows more accurate management of these high risk category of patients and contributes to a more efficient organization of a renal department.
MO706PATIENTS AND CENTER-RELATED FACTORS IN PERIOTONEAL CHOICE IN INCIDENT PATIENTS: A REGIONAL EXPERIENCE
Authors: Panuccio Vincenzo Antonio , Parlongo Giovanna , Tripepi Rocco , Tripepi Giovanni Luigi , Cianfrone Paola , Mollica Agata
Published: May 2021

Background and Aims

Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular.

Method

The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver.

Results

The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain.

Conclusion

These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.