bluuebunny/crossref_metadata_2025 huggingface dataset:
P1542DIALYSIS MODALITY AND OUTCOMES IN GERIATRIC END STAGE RENAL DISEASE (ESRD) PATIENTS. AN ASIAN SINGLE CENTER EXPERIENCE
Authors: Supayah Jeevita , Wong Hin Seng , Lee Fei Yee , Yakob Suryati
Published: June 2020

Background and Aims

The prevalence of CKD increases with age and more elderly patients are on maintenance dialysis as advanced age is no longer an impediment. The selection of dialysis modality can be difficult for the simultaneous benefit and burden of individual modality on top of the complexity of co-morbidity and quality of life.

To study the survival outcomes based on dialysis modality in geriatric ESRD patients

Method

The cohort of geriatric patients (aged > 65 years) with ESRD who were referred to our pre-dialysis clinic from 1st January 2016 to 31st December 2018 and started on maintenance dialysis were identified via the hospital information system. Demographics, co-morbidities, dialysis modalities and clinical outcome in terms of survival were obtained from the hospital electronic medical record. Glomerular filtration rates (eGFR) were calculated using the CKD-EPI formula in mls/min/1.73m2. The statistical analysis was done using SPSS version 23.

Results

A total of 145 geriatric ESRD patients were initiated on chronic dialysis. The cohort was predominated by male with 77 patients (53.1%). The mean age was 72.5±5.2 years. Majority had multiple comorbidities with 95% having hypertension, 82.8% with diabetes, 65.5% and 32.8% having dyslipidemia and ischemic heart disease, respectively. The mean eGFR at point of referral and dialysis initiation were 12.5±4.9 mls/min/1.73m2 and 6.57±2.33 mls/min/1.73m2 respectively. Mean duration to initiate dialysis from first review was 6.7±5.8 months.

Majority opted for hemodialysis (HD) with 106 patients (73.1%). 74% patients in the HD cohort initiated dialysis via a catheter and remainder with an arteriovenous fistula (AVF). 39 patients (27.1%) opted for peritoneal dialysis (PD) and all were initiated via tenckhoff catheter. Mean eGFR at dialysis initiation were 6.44±2.47 (HD) and 6.9±1.9(PD) respectively.

At 6 months, all PD patients survived and 18.2% of HD patients died with statistically significance difference at p=0.003. No survival predictors were identified.

Conclusion

PD modality has advantage in survival outcome in geriatric ESRD patients.
P1546UK ANNUAL THERAPY COST OF DIALYSIS WITH THE QUANTA SC+ PERSONAL HAEMODIALYSIS SYSTEM
Authors: Ferguson Thomas , Komenda Paul , Harper Gerard , Milad John
Published: June 2020

Background and Aims

The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system.

Method

Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP.

Results

Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits.

Conclusion

In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.
P1550ACCESS TO KIDNEY TRANSPLANTATION IN A NON-PROFIT FACILITY IN GERMANY
Authors: Kemmner Stephan , Arns Wolfgang , Von Gersdorff Gero , Bach Rolf Dieter , Fischereder Michael
Published: June 2020

Background and Aims

Recent studies demonstrate that US patients undergoing chronic dialysis treatment for end stage renal disease (ESRD) at for-profit facilities had a lower access to kidney transplantation than patients at non-profit facilities. However, even at non-profit facilities only around 20% of patients were placed on the kidney transplantation waiting list. At first glance, this number appears rather low, as kidney transplantation is the only way to curatively treat ESRD.

We want to compare these figures with a recently performed survey in Germany.

Method

We analyzed the status of transplant evaluation in the largest non-profit facility in Germany, the Kuratorium für Dialyse und Nierentransplantation e.V. (kfh, www.kfh.de). In total, the transplant status was assessed in 16,705 patients.

Results

Out of these only 19.4% of patients (n=3241) are on the kidney transplant waiting list, comparable to recently performed US studies. The reason why patients are not waitlisted are multifaceted as seen in attached figure. Due to severe comorbidities about 50% are considered too sick to benefit from transplantation, in turn representing the complex and high multi-morbidity of patients with ESRD. On the other hand, approximately 10% of dialysis patients actively decline listing for renal transplantation at least at some point.

Conclusion

We conclude that further research is needed to identify and break the mechanisms behind the low likelihood for access to kidney transplantation waiting list.

Distribution of patients with surveyed transplant status in the largest non-profit dialysis facility (kfh, www.kfh.de) in Germany
P1564SLEEP QUALITY ASSESSMENT ON HÉMODIALYSIS
Authors: Maha Cheikh , Soumaya Chargui , Fathi Ben hmida , Taieb Ben abdallah
Published: June 2020

Background and Aims

sleep disorders are a major public health problem, affecting the majority of patients with end-stage chronic kidney disease.

The purpose of this work is to assess the quality of sleep and identify the associated factors.

Method

This is a single-center cross-sectional study of 57 patients on conventional hemodialysis. Clinical screening was conducted using the Epworth Sleepiness Scale.

Results

The average age of the patients was 53.43 years (between 25 and 82 years), with a sex ratio of 1.08. The socio-economic level was considered bad in 70% of the cases. The main co-morbidities are hypertension in 50.8% of cases and diabetes in 24.5% of cases. The average seniority on hemodialysis was 7.47 years. 53% of patients had sleep disorders and they were insomnia in 39% of cases, daytime sleepiness in 59% of cases of which it was excessive (Epworth score> 15) in 15% of cases, a syndrome restless legs in 3% of cases and obstructive sleep apnea with snoring in 13% of cases.

Conclusion

The prevalence of sleep disorders is higher in hemodialysis patients than in the general population, and they are associated with a non-negligible cardiovascular risk, hence the importance of early detection and adequate management, thereby improving the quality of life of these patients.
P1566SKELETAL MUSCLE MASS BY COMPUTED TOMOGRAPHY AT THE LEVEL OF THE THIRD LUMBAR VERTEBRA AND MORTALITY IN END-STAGE KIDNEY DISEASE
Authors: Sabatino Alice , Regolisti Giuseppe , Delsante Marco , Di motta Tommaso , Parmigiani Alice , Peyronel Francesco , Maggiore Umberto , Fiaccadori Enrico
Published: June 2020

Background and Aims

Protein-Energy Wasting (PEW) is highly prevalent in patients with end-stage kidney disease on chronic hemodialysis (ESKD-HD). In such clinical setting PEW is associated to poor outcomes. The assessment of nutritional status is essential for the identification of patients at risk for the development of PEW. In the contest of nutritional evaluation, increasing attention is currently paid to the assessment of muscle mass, which represent the major protein asset in the body. Currently available bedside tools used for the assessment of nutritional status are not accurate enough for the assessment o skeletal muscle mass. In this clinical setting, the use of “gold standard” imaging methods (such as CT sca, DEXA or MRI) could allow a more accurate assessment of body composition. The aim of our study was to assess the correlation between skeletal muscle mass on the level of the third lumbar vertebra (L3) assessed by CT scan with mortality in ESKD-HD.

Method

In a retrospective observational study, 1260 ESKD-HD patients undergoing chronic hemodialysis treatment were identified between 2008 and 2015 in the Dialysis Centers of the National Health Service in the province of Parma. Among these patients, those with at least one available abdomen CT scan after the patient had already been on dialysis for at least 6 months were enrolled. The CT images obtained at the level corresponding to the L3 were analyzed using a dedicated software, in order to extrapolate the data related to the quantity of skeletal muscle tissue.

Results

We enrolled 183 ESKD-HD patients, aged 68.8 (± 15.1) yrs, 64% (117/183) males, median hemodialysis vintage 43.9 (range 6 – 208) months. The cohort was characterized by a high comorbidity burden, with a median Charlson Comorbidity Index of 9 (range 2-17). Baseline skeletal muscle mass at L3 was 118.5 cm2 (± 30.6). Median follow-up was 65.6 (range 6.6 – 132.5) months. During follow-up, 67% (122/183) of patients died.

Patients were divided based on quartiles of muscle mass. Patients in the first quartile had 83% mortality, while mortality of patients in the fourth quartile was 52% (OR = 4.16 95% CI = 1.59 – 10.87; P = 0.003). Kaplan-Meier analysis identified significantly lower survival in patients in the first quartile of muscle mass compared to those in the fourth quartile (P = 0.03 at the Mantel-Cox Log-rank test) (Figure 1).

Conclusion

Low muscle mass by CT scan appears to be associated with an increased risk of mortality in ESKD on chronic hemodialysis.
P1568EFFECTS OF VOLUME STATUS ON BODY COMPOSITION IN INCIDENT PERITONEAL DIALYSIS PATIENTS
Authors: Kang Seok Hui , Park Jong Won , Cho Kyu Hynag , Do Jun Young
Published: June 2020

Background and Aims

Volume control is the most important issue in peritoneal dialysis (PD). Inadequate fluid removal or high water intake leads to overhydration, which result in malnutrition. Sarcopenia (SP) as a result of malnutrition is more prevalent in PD than in the general population, and is associated with high mortality and low quality of life in PD patients. The aim of the present study was to evaluate the effects of volume status on body composition in incident PD patients.

Method

This retrospective study was performed at a tertiary medical center from January 2001 to March 2015. All incident PD patients who survived ≥1 year after PD initiation were considered eligible. 366 incident PD patients were finally included and divided into 3 tertiles according to the time-averaged-edema index (TA-EI). Edema index was calculated by dividing extracellular water values by total body water values. The mean of the EI values at 1 month and 1 year was defined as TA-EI. The body composition parameters measured using bioimpedance analysis included the EI, fat mass index (FMI, kg/m2), and appendicular muscle mass index (AMMI, kg/m2). dFMI and dAMMI were defined as delta values for each variable. The cutoff value for sarcopenia (SP) was defined as previously reported (The cutoff value for SP was defined as AMMI ≤ 7.0 kg/m2 in men and ≤ 5.7 kg/m2 in women). Patients with AMMI below the cut-off values were defined as having SP.

Results

The number of participants in the low, middle, and high tertiles was 126, 100, and 140, respectively. The TA-EI in the low, middle, and high tertiles was 0.384 ± 0.006, 0.398 ± 0.003, and 0.413 ± 0.009, respectively (P < 0.001). A high volume status was associated with high solute clearance, peritoneal albumin loss, and glucose absorption through the peritoneal membrane, which led to high dialysate glucose. In addition, volume status was inversely associated with increases in AMMI, but was not associated with changes in FMI. SP as a categorical variable was positively associated with a high volume status. On subgroup analyses, TA-EI had the greatest negative correlation coefficients for dAMMI.

Conclusion

Overhydration in PD patients was associated with decrease in muscle mass indices and the development of SP.
P1576THE EFFECT OF CHANGING DIETARY PHOSPHORUS-PROTEIN RATIO ON NUTRITIONAL STATUS OF HEMODIALYSIS PATIENTS
Authors: Wang Song , Tian Xinkui , Lu Xinhong , Liu Hanmin , WANG YUE
Published: June 2020

Background and Aims

To investigate the effect of changing dietary phosphorus-protein ratio on the nutritional status of maintenance hemodialysis patients.

Method

Hemodialysis patients who had average serum phosphorus ≥1.78 mmol/L for three consecutive months were enrolled in this self-controlled trial. Patients received low phosphorus diet instruction for 4 weeks as baseline, followed by changed the diet of staple foods with the same amount of low protein rice for 10 weeks. The difference of protein intake between the low protein rice and staple foods was replaced by low phosphorus whey. Then the patients reverted to staple food for 8 weeks. Serum phosphorus, albumin and nutritional status before and after dietary changes were observed and analyzed.

Results

29 patients completed the study. At baseline dietary phosphorus-protein ratio was (15.85±3.29) mg/g, and serum phosphorus was (2.05±0.32) mmol/L. After switch to low protein rice and low phosphorus whey for 10 weeks, dietary phosphorus-protein ratio decreased to (12.18±2.45) mg/g (p<0.001). Simultaneously serum phosphorus decreased to (1.87±0.44) mmol/L (p=0.048). Nutritional status evaluation showed the patients’ serum albumin increased significantly compared with baseline (42.29±3.51 vs. 39.84±3.23 g/L, p<0.001), as well as dry body weight (65.09±15.30 vs. 64.71 ± 15.07 kg, p=0.030), upper arm muscle circumference (22.57±2.83 vs 22.00±3.03 cm, p=0.013), and the grip strength (27.89±7.82 vs. 26.54±7.90 kg, p=0.032). Subjective global assessment (SGA) and serum lipid level did not change significantly after the food change.

Conclusion

For hemodialysis patients, changing dietary phosphorus-protein ratio by combination of low protein rice and low phosphorus whey could effectively decrease serum phosphorus level, and improve serum albumin, as well as muscle mass and muscle strength.
P1577DOES VITAMIN E -COATED MEMBRANES INFLUENCE ON MARKERS OF OXIDATIVE STRESS IN HEMODIALZSIS PATIENTS WITH HOMOZYGOUS GST M1 GENE DELETION?
Authors: Djuric Petar , Suvakov Sonja , Markovic Dragana , Jovanovic Djurdja , Jankovic Aleksandar , Bulatovic Ana , Tosic Dragovic Jelena , Marinkovic Jelena , Naumovic Radomir , Simic Tatjana , Dimkovic Nada
Published: June 2020

Background and Aims

Increased free radicals production and down-regulated antioxidant enzymes activities contribute to protein, lipid and DNA oxidative damage particularly in HD patients lacking for GSTM1 enzyme activity. At the same time, those patients exhibit higher mortality rate than those with active GSTM1 genotype. It has been shown that vitamin E-coated membranes (VitEM) may decrease oxidative stress and inflammatory status in overall HD patients. Therefore, for the first time we analyzed VitEM dialyzers in patients who are homozygote for GSTM1 gene deletion and in whom anti-oxidative and anti-inflammatory benefit could be the greatest.

Method

GSTM1 genotypes were determined by PCR in 170 chronic HD patients. Those with GSTM1-null genotype were randomized and 80 were included in the study. Forty of them were dialyzed for three months with VitEM, while other forty were dialyzed with high-flux polysufone membranes of the same surface. Markers of protein and lipid oxidative damage, inflammation (thiol groups, malondialdehyde (MDA), Interleukin-6 (IL-6)), together with plasma antioxidant activity (glutathione peroxidase (GPX), superoxide dismutase (SOD)) were determined at the start and at the end of the study.

Results

Seventy-five patients’ finished the study. There were no significant differences in baseline characteristics between the two groups (age, sex, body weight, dialysis vintage, vascular access, presence of diabetes, dialyzers surface, Kt/V and CRP). Also, there were no significant differences at baseline markers of protein and lipid oxidative damage, inflammation and plasma antioxidant activity. After three months of therapy, GPX, MDA, thiol groups increased significantly in both groups, but without statistical significance between groups (Table 1). SOD did not change significantly during three month period. IL-6 increased in control group, at the same time decreased in VitEM group, but without statistical significance.

Conclusion

Vitamin E-coated membranes did not influence markers of oxidative stress in HD patients with GSTM1-null genotype. Further studies in the field are required.
P1580LONGITUDINAL CHANGES IN BODY COMPOSITION ARE ASSOCIATED WITH ALL-CAUSE MORTALITY IN PATIENTS ON PERITONEAL DIALYSIS
Authors: Song Young Rim , Kim Sung Gyun , Lee Hyung-Seok , Kim Hyung Jik
Published: June 2020

Background and Aims

Peritoneal dialysis (PD) is associated with a number of adverse body compositional changes, including fat gain and muscle wasting. Whether body compositional changes are associated with the long-term prognosis is uncertain. The purpose of this study was to analyze the effects of longitudinal changes in body composition on all-cause mortality in PD patients.

Method

PD patients were subjected to bioimpedance spectroscopy (BIS) and handgrip strength (HGS) at baseline and after 2 years. Among 160 patients, 131 patients were tested with a repeat BIS and HGS. Lean tissue index (LTI) loss and fat tissue index (FTI) gain were defined as a 10% decline in LTI and a 10% gain in FTI, respectively after 2 years.

Results

The prevalence of sarcopenia at baseline was 13.8%. After 2 years, LTI loss and FTI gain were observed in 40 (30.5%) and 58 (44.3%) patients, respectively. Baseline clinical factors did not predict longitudinal body compositional changes, and there was a negative association between changes in the LTI and FTI (r = –0.574, p < 0.001). Low LTI and low HGS at baseline were significant predictors of all-cause mortality after adjusting for demographic and biochemical parameters, but not when cardiovascular factors were included in the multivariate analysis. However, LTI loss and FTI gain were independent risk factors for all-cause mortality after adjusting for demographic, biochemical, and cardiovascular parameters.

Conclusion

In PD patients, longitudinal changes in LTI and FTI were more strongly associated with all-cause mortality than single values in LTI and FTI.
P1589COMPARISON OF NUTRITIONAL STATUS IN HEMODIALYSIS PATIENTS WITH AND WITHOUT ANXIETY/DEPRESSION
Authors: Akagun Tulin , Türkmen Sembol , Arslan Aylin
Published: June 2020

Background and Aims

Approximately one-third of all dialysis patients have mild to moderate malnutrition, while 6-8% have severe malnutrition. In patienst receiving maintenance hemodialysis, a low serum prealbumin is an indicator of malnutrition. Depression and anxiety are the most common psychological disorders in patients undergoing hemodialysis. The aim of this study was to evaluate the nutrional status in our hemodialysis patients and its association with anxiety and depression.

Method

In our cross-sectional study, 61 hemodialysis patients were evaluated with mini nutrional assessment (MNA) form, Beck anxiety/depression scale, clinical and laboratory data.

Results

Of 61 hemodialysis patients; 37 were male (mean age 60,8±11.7). 11.5 % of patients were malnourished. Severe depression and anxiety rates were 14.8% and 21.3% respectively. The clinical parameters of hemodialysis patients are shown in Table-1 and clinical and laboratory findings of the hemodialysis patients according to MNA scores are shown in Table-2. Malnourished patients and patients who were at risk of malnutrition; had lower urea, creatinine and prealbumin levels.

Conclusion

Anxiety was more prevalant in malnourished hemodialysis patients with lower prealbumin levels.

Figure-1

Clinical and laboratory findings of hemodialysis patients (n=61).

Figure-2: Clinical and laboratory findings of the hemodialysis patients according to MNA scores.
P1591SERUM PARAOXONASE 1 ARYLESTERASE ACTIVITY AS AN ANTIOXIDANT MARKER IN DIALYSIS PATIENTS
Authors: Korol Lesya , Stepanova Natalia , Vasylchenko Victoria
Published: June 2020

Background and Aims

Patients with chronic kidney disease (CKD) have the highest risk for cardiovascular disease associated with high-density lipoprotein deficiency, chronic inflammation and the development of oxidative stress (OS).

This study aimed to investigate serum paraoxonase 1 (PON-1) arylesterase activity in patients with end-stage renal disease (ESRD) and its association with oxidative stress markers.

Method

We conducted a cross-sectional observational study involving 58 ESRD patients. Among them, there were 20 hemodialyses (HD) patients and 38 patients treated with peritoneal dialysis (PD).

Serum PON1 arylesterase activity was determined spectrophotometrically by the number of formed phenolic complexes using phenylacetate. Also, the concentrations of malondialdehyde, serum concentrations of ceruloplasmin, thiol groups and total peroxidase activity (TPA) in erythrocyte were determined spectrophotometrically. In addition, the blood lipid spectrum (including high-density lipoproteins) was determined in all patients.

The reference group consisted of 30 conditionally healthy individuals.

For the statistical analysis, we used Kruskal-Wallis’s t-test and Spearman's rank correlation test. All statistical analyses were performed using MedCalc.

Results

Serum PON1 arylesterase activity was 6.57 kU/L in reference group versus 2.25 kU/L in HD patients and 4.26 kU/L in PD patients (p < 0.0001) (Fig. 1). A direct association was found between serum PON1 arylesterase activity and ceruloplasmin concentration (r = 0.38; p = 0.004) and TPA (r = 0.32; p = 0.02) in HD patients. In iddition, serum PON1 arylesterase activity was associated with high-density lipoproteins (r = 0.67; p < 0.0001) in PD patients (Fig. 2).

Conclusion

We observed a decrease in serumPON1 arylesterase activityin ESRD patients compared to the control group. The lowest level of serum PON1 arylesterase activity was determined in HD patients. Moreover, the association between serum PON1 arylesterase activity and a decrease in antioxidant blood markers was found.

Our results support the hypothesis that OS is an important mediator in the progression of kidney diseases and indicates a potential antioxidant role of serum PON1 arylesterase activity in ESRD patients. We suggest using serum PON1 arylesterase activity as an antioxidant marker in dialysis patients.
P1595NUTRITION AND INFLAMMATORY STATUS IN DIALYISIS PATIENTS WITH SUICIDAL IDEATION AND DEPRESSION
Authors: Ruvalcaba Contreras Neri , Márquez Herrera Roxana Michel , Valencia Coronado Rosalinda , Calderón Fabián Alejandro , López Alvarado Sandra Estefania , Cortés Sanabria Laura , Cueto Manzano Alfonso Martín , Rojas Campos Enrique
Published: June 2020

Background and Aims

The main precursor of suicidal ideation is depression, which is the most common psychiatric disorder in dialysis patients. Studies have shown an association of depression with nutritional alterations and systemic inflammation; however, in patients with kidney disease there is no data about a possible relation between malnutrition, inflammation and suicidal ideation. Therefore, the aim of this study was to describe and compare the nutritional and inflammation statuses in dialysis patients with suicidal ideation and depression.

Methods

Cross sectional study; 36 dialysis patients >18 years old, any gender, who signed informed consent were included. Suicidal ideation was measured by one psychiatrist using the Beck Scale for Suicidal Ideation, and depression with the Beck Depression Inventory. A dietitian evaluated nutritional status by means of anthropometric and biochemical variables, and the Dialysis Malnutrition Score. Additionally, C-reactive protein and fibrinogen were measured. Results were classified as dichotomous variables for suicidal ideation (yes/no) and depression (no: normal-mild/ yes: moderate-severe).

Results

Prevalence of depression, suicidal ideation and malnutrition were 97%, 63% and 31%, respectively. Main results are shown in the table.

Conclusions

Patients with suicidal ideation and depression did not show significant differences in any of the assessed nutritional variables. However, patients with suicidal ideation and depression seemed to have higher concentrations of C-reactive protein and fibrinogen. The present study opens an opportunity for future research.
P1597USE OF FEBUXOSTAT IN HYPERURICEMIC PATIENTS UNDERGOING DIALYSIS: TOLERABILITY AND EFFICACY IN INDIAN POPULATION
Authors: Sharma Sourabh , Sharma Neha
Published: June 2020

Background and Aims

Hyperuricemia is associated with increased vascular events in chronic kidney disease (CKD). Febuxostat is an effective alternative treatment in this subset but there is scarcity of data on its use in patients undergoing dialysis. The aim of our study was to evaluate efficacy and safety profile of febuxostat in hyperuricemic Indian patients on dialysis.

Method

Fifty four patients with CKD stage 5D and hyperuricemia were included in the study from Jul 2018 to Mar 2019. Febuxostat was started and patients followed-up over 6 months for decline in uric acid and any adverse events.

Results

Out of 54 cases, 30 were males (55.56%). Mean age was 51.28±16.9 years. Thirty two cases were diabetic (59.26) and all cases were on two or more antihypertensives. Nine cases were suffering from gout at time of inclusion and mean serum creatinine in these cases was 10.47 mg/dl. Symptomatic cases responded to treatment within 2 weeks of therapy. Mean serum uric acid level at 3 months post-treatment (4.65±0.96 mg/dL) was significantly reduced compared from pre-treatment level (8.34± 1.18 mg/dL) [p<0.01]. Serum uric acid level remained significantly low for 6 months without deterioration in eGFR. Blood pressure remained well controlled during therapy period and only four cases required increment of antihypertensive medication. Out of 54 cases, five stopped medication due to adverse events. Out of them, three cases were on peritoneal dialysis. Three cases developed skin rash which subsided once drug was withheld. Most common side effect was nausea (7/54) and headache (6/54).

Conclusion

Febuxostat at a low dose of 40 mg/dl is well tolerated among dialysis population. It effectively declines serum uric acid level. Gastrointestinal side effects are most common adverse event which corresponds to non-dialysis population. There was no higher risk of skin rash or other major adverse event in this subset. It is also worth mentioning that hyperuricemia is associated with significant vascular events and all cases included in study were hypertensive.
P1598USE EXPERIENCE OF FIRAPY (FAR-INFRARED THERAPY) TREATMENT FOR WOUND OF HEMODIALYSIS PATIENTS
Authors: Maeda Kunimi , Wada Takaaki , Ikeda Shihoko
Published: June 2020

Background and Aims

By using far-infrared irradiation, Firapy treatment is expected to improve blood flow by expanding peripheral blood vessels and an effect of promoting wound healing due to its non-thermal effect.

The aim is to discuss the clinical effects of Firapy treatment applying to dialysis recipients with lower extremity wounds.

Method

Two dialysis patients with diabetic nephropathy who developed lower extremity wounds were included in this study. Starting from the initial stage of the wound, patients received wound rinsing at each dialysis, followed by a 30-minute Firapy treatment. The following items were observed over time from the beginning of the treatment. Evaluation and examination were then conducted.

(1) The wound healing process was evaluated over time from wound measurements, images, and records.

Results

In both cases, early initiation of Firapy treatment resulted in good healing without leaving any signs of infection or scarring. By using far-infrared irradiation, Firapy treatment has been considered to be an effective therapeutic means due to it could enhance angiogenesis and microcirculation which allows restoration of blood flow in ischemic tissue and its effect of promoting wound healing.

Conclusion

Appling Firapy treatment to the wound showed the possibility of making wound healing be faster and healed beautifully. Firapy treatment has been considered to be one of effective way to wound healing. We are looking forward to use Firapy treatment for other cases.
P1599USE OF ASCORBATE-RICH DIALYSATE IN HEMODIALYSIS PATIENTS
Authors: GRIVEAS IOANNIS
Published: June 2020

Background and Aims

Increments of oxidative stress have been addressed as one potential cause for the accelerated atherosclerosis of chronic kidney disease patients. Ascorbate (vitamin-C) represents one of the most prominent antioxidants both in plasma and intracellulary. Unsupplemented dialysis patients have reportedly lower plasma levels of ascorbate in comparison to healthy controls, mostly due to a loss into the dialysate. Purpose of our study was the recording of the experience of the use of Ascorbate-Rich Dialysate in patients under hemodialysis (HD).

Method

11 HD patients were recruited for the study. During a period of 8 weeks they were receiving Ascorbate-Rich Dialysate (2g/lt). Ascorbic acid levels were estimated before and at the end of the study period. We also monitored patients’ anemia profile (Hb, Hct, ferritin, TSAT, rhEPO dose), lipid and nutrition status.

Results

Ascorbic acid values were towards the lower accepted levels in our patients (3.25±1.01 mg/l) at the beginning of the study period. After 8 weeks receiving Ascorbate-Rich Dialysate, acorbic-acid levels were significantly increased (6.87±1.50 mg/l) without transcending the upper accepted limit. During the notice period, our patients were behaved normally without any sort of adverse events. Mean Hct levels remained stable (39.10±3.70% with conventional dialysate vs 39.67±1.59 % with usage of ascorbate-rich dialysate ). The same conclusion was noticed with Hb levels (12.85±1.20 vs 13.15±0.49). Mean rhEPO dose per week (epoetin- alfa) decreased (9000±5200 iu vs 6250±4300 iu, p=NS) and administration of Fe stopped to all of our patients. Ferritin (>700), TSAT (>35) remained stable over the whole study period. Cholesterol, triglycerides and albumin levels did not change significantly with the change of the conventional dialysate to ascorbic-rich one.

Conclusion

Although our study is limited by small numbers of subjects, short durations of follow-up, our results suggest that compared with standard care, ascorbic acid in dialysate bath is a safe choice to increase ascorbic-acid levels in traditionally vitamic C depleted HD patients within safe limits. This raise seems to favors anemia profile of HD population. Longer term studies are required to confirm these results, determine whether these changes translate into improved patient outcomes and cost-effectiveness.
P1604SIGNIFICANT DETECTION OF UNEXPLAINED HLA ANTIBODIES WITH SINGLE-ANTIGEN BEADS IN PATIENTS ON THE WAITING-LIST WITHOUT PREVIOUS SENSITIZING EVENTS
Authors: Núñez Delgado Sara , Burballa Tarrega Carla , Caro José Luis , Arias Cabrales Carlos , Mir Fontana Marisa , Pérez Sáez María José , Palou Eduard , Pascual Santos Julio , Redondo Pachón M Dolores , Crespo Barrio Marta
Published: June 2020

Background and Aims

The introduction of more sensitive and specific tools as solid phase immunoasssays has improved the ability to detect HLA antibodies. The techniques based on solid phase immunoassays in Luminex system can be performed either as screening assays (with pooled antigen panels that use bead populations coated in affinity-purified class I or class II HLA molecules) or to assess the specificity with single-antigen bead (SAB) assays (single cloned allelic HLA antigen).The sensitivity of each assay Is different, and their results may be discordant. Our objective was to evaluate the potential discrepancies between tests in a cohort of patients on our waiting list with no previous sensitizing events, for their potential influence in the access to transplantation.

Method

Observational study of 184 patients included in the kidney-transplant waiting list on March 31st, 2019. All possible sensitizing events (pregnancy, transfusion and previous transplants) were registered. HLA antibodies where analyzed both by screening and SAB tests.

Results

We limited the observations to males (64.7% of the cohort), as most women (95.4%) had a known sensitizing event, not being possible to discard possible pregnancies in the remaining. Of men, 46.2% had a sensitizing event and 63.8% did not. All 63 unsensitized patients showed a negative screening test, and 49 (77,78%) had at least one SAB done being positive in 73.4% (36/49). The positive SAB yielded a cPRA >10% in 30 cases (between 21-85%), mostly (27/30) due to HLA class II antibodies (88.8% with at least one DQ antibody) with a median MFI of 1571 (range:752-17650).

A thorough review of specificities showed that 81% DQB1* and 89.6% DQA1* antibodies did not show consistency in all beads included for the same allele.

Conclusion

Screening and SAB assays show a significant discordancy in unsensitized men included in the waiting list for kidney transplantation. Automated detection of antibodies by SAB without a proper specialized interpretation may wrongly limit access to transplantation.
P1605THE EARLY RISE OF URINARY EXOSOMAL BK VIRUS MICRORNA AS A PREDICTIVE MARKER FOR BK VIRUS NEPHROPATHY IN A PROSPECTIVE KIDNEY TRANSPLANTATION COHORT
Authors: CHO WON HEE , Jung Su Woong , Seo Jung Woo , Moon Ju-Young , Jeong Kyung Hwan , Kim Chan Duck , Chung Byung Ha , Kim Yeong Hoon , Lee Sang ho , Park Jae Berm , KIM MI JI
Published: June 2020

Background and Aims

BK virus nephropathy (BKVN) is one of the significant contributors to allograft dysfunction in kidney transplantation. Because of the lack of effective anti-viral medication, early detection of BKV replication and preemptive management is vital to preserving allograft function. Herein, we investigated the predictive value of urinary exosomal BKV-microRNA for BKVN in the kidney transplantation cohort.

Method

ARTKT (assessment of immunologic risk and tolerance in kidney transplantation) is a prospective observational cohort in which a total of 420 kidney transplant recipients were enrolled from 7 teaching hospitals in South Korea since 2015. Urine samples were collected at 0.5, 3, 6, 12, and 24 months after kidney transplantation in this cohort. All enrolled patients were reviewed to identify the patients diagnosed with BKVN histologically (biopsy-proven BKVN) and those experienced BK viremia defined as plasma BKV DNA load > 4 log10 copies per mL (presumptive BKVN). Urinary exosomal miR was quantified using real-time reverse transcription PCR.

Results

10 patients and 14 patients developed biopsy-proven BKVN and presumptive BKVN, respectively. Because of unavailable urine samples, urinary exosomal BKV-microRNA was investigated in 8 patients with biopsy-proven BKVN and 13 patients with presumptive BKVN. 61 patients with no evidence of BKVN were selected as a negative control. Most of BKVN was developed in a median time of 3.4 months after transplantation. In line with this pattern, urinary exosomal BKV-microRNA peaked at 3 months after transplantation and decreased thereafter in biopsy-proven BKVN and presumptive BKVN, keeping higher value in biopsy-proven BKVN compared to presumptive BKVN after 3 months. At 2 weeks after transplantation, half of the patients with biopsy-proven BKVN showed an early rise of urinary exosomal BKV-microRNA, whereas patients with presumptive BKVN and no evidence of BKVN did not. However, plasma BK virus DNA was not detected in all groups at 2 weeks after transplantation. In multivariate cox proportional hazards model, urinary exosomal BKV-microRNA was significantly associated with biopsy-proven BKVN.

Conclusion

A urinary exosomal BKV-microRNA increase as early as 2 weeks after kidney transplantation predicts future BKVN development, enabling early intervention.
P1608CXCL13 IS STRONGLY INDUCED BY RENAL ISCHEMIA REPERFUSION INJURY AND CORRELATES WITH SEVERITY OF RENAL INFLAMMATION
Authors: Jang Mi-Sun , Kreimann Kirill , Greite Robert , Rong Song , Von Vietinghoff Sibylle , Schmitt Roland , Dittrich-Breiholz Oliver , Bräsen Jan Hinrich , Vijayan Vijith , Haller Hermann , Immenschuh Stephan , Gueler Faikah
Published: June 2020

Background and Aims

Ischemia reperfusion injury (IRI) is a strong trigger of inflammation and is tightly linked to renal allograft damage and function. CXCL13 or B lymphocyte chemoattractant (BLC) is a chemokine that controls B cell organization in lymphoid tissues and has recently been described as a biomarker for B cell involvement in acute kidney allograft rejection.

Method

To show, that CXCL13 is already induced by IRI alone we used renal IRI models in mice with different ischemia times and a kidney transplantation model. We measured serum CXCL13 and characterized cell infiltrates by immunohistochemistry and performed single cell RNA sequencing. Allogenic and isogenic kidney transplantation (KTX) in mice was done to evaluate these findings in the transplant setting.

Results

Systemic CXCL13 levels increased within hours after surgery in a time dependent manner, both after induction of IRI and KTX. Levels of CXCL13 increased with duration of ischemia time and were higher in allogenic than isogenic transplantation with equal duration of ischemia. CXCR5, the receptor for CXCL13, is mainly expressed on B lymphocytes but also on a subset of T lymphocytes and macrophages. CXCR5 positive infiltrates were detected in IRI kidneys seven days after injury. In kidney allografts interstitial B cell infiltrates were observed as early as seven days and increased further towards three weeks after KTX.

Conclusion

The current findings indicate that IRI is a strong trigger of CXCL13 expression in the kidney and release into the circulation, which is followed by B lymphocyte infiltration into damaged tissue in ischemic and renal allografts.
P1615IDENTIFICATION OF URINARY PROTEOMIC PROFILE OF PATIENTS WITH CHRONIC ALLOGRAFT NEPHROPATHY
Authors: Khalifa Amr , El-Wakil Hala , El-Aggan Hayam
Published: June 2020

Background and Aims

Chronic allograft nephropathy (CAN) is a major complication that occurs post-transplantation. At present, the diagnosis of chronic allograft nephropathy (CAN) is based on renal biopsy. Therefore, there is an ultimate need to identify more specific and sensitive noninvasive methods for the early diagnosis of CAN. Recently, proteomic-based modalities have been developed to discover biomarkers of CAN.

Method

Urine samples from 75 participants were collected. Participants were divided into 3 groups: Group I: 25 patients with chronic allograft nephropathy, group II: 25transplanted patients with stable renal functions, and group III: 25 healthy control subjects matched for age and sex. Each group was divided into training set and test set. Specimens were purified with magnetic beads-based weak cation exchange chromatography and analyzed in a MALDI-TOF MS.

Results

A Genetic Algorithm (GA) was used to set up the classification models. Five peaks represented the proteomic profile that differentiates between the CAN patients and the control group with sensitivity of 100%, specificity of 100%, recognition capability of 100 % and cross-validation91.7 % and five peaks differentiate between the transplant patients with normal renal functions and the control groups with sensitivity of96.8 %, specificity of  95.5 %, recognition capability of 98 % and cross-validation of 100 %.

Conclusion

We identified a pattern for CAN and transplant patients with normal renal functions by proteomic profiling using MALDI-TOF-MS and magnetic beads.
P1617RENAL TRANSPLANT PATIENTS HARBOR NEUTROPHILS SECRETING B-CELL ACTIVATING FACTOR (BAFF) WHICH CAN BE SUPPRESSED BY MTOR INHIBITORS
Authors: Steinberg Hannah , Dolff Sebastian , Kribben Andreas , Ma Xin , Witzke Oliver , Wilde Benjamin
Published: June 2020

Background and Aims

B cell activating factor (BAFF) is a cytokine which drives B cell survival and maturation. Several studies have shown that elevated BAFF levels in renal transplant patients are associated with increased risk for the development of donor specific antibodies and antibody mediated rejection. It was the aim of this study to investigate neutrophils as cellular source of BAFF in renal transplant patients.

Method

Neutrophils (NT) were freshly isolated from whole blood of healthy controls (HC) and renal transplant patients (RTX). After isolation, purity of neutrophils was usually above 98%. Neutrophils were stimulated with LPS or TNFα in presence of Granulocyte-colony stimulating factor (GCSF) or Granulocyte macrophage colony-stimulating factor (GMCSF). In selected conditions, FK506 or rapamycin was added. Supernatants were harvested after 20 hours of culture and BAFF levels were determined by ELISA.

Results

GCSF/TNFα and GCSF/LPS were the most potent stimuli leading to BAFF secretion of NT in HC (403 ±64 pg/ml and 421 ±69 pg/ml). NT derived RTX showed similar capacity to secrete BAFF as compared to HC (GCSF/TNFα: 515 ±31 pg/ml and GCSF/LPS: 539.4 ±36 pg/ml). Treatment of cultures with rapamycin reduced BAFF levels (515 ±100 pg/ml vs. 348 ±27 pg/ml, p<0.001). Treatment with FK506 was less efficacious (515 ±31 pg/ml vs. 465 ±31 pg/ml, p=0.01).

Conclusion

NT may enhance of B cell maturation and survival via BAFF. BAFF-secretion by NT can be suppressed with mTOR inhibitors. In renal transplantation, NT might promote formation of allo-antibodies and drive antibody mediated rejection.
P1629THE COMBINATION OF KDRI AND THE HISTOLOGICAL SCORE IMPROVES THE RISK STRATIFICATION OF MARGINAL ORGANS IN KIDNEY TRANSPLANTATION
Authors: Fiorentino Marco , Pesce Francesco , Simone Simona , Castellano Giuseppe , Gallo Pasquale , Battaglia Michele , Gesualdo Loreto
Published: June 2020

Background and Aims

The organ shortage has led to increase the procurement of kidneys from marginal donors, but the risk of graft failure is still object of debate. The aim of the study is to assess whether using both clinical and histological scores can better assess the risk for worse outcome for marginal organs.

Method

We analyzed 210 kidney transplant recipients from donors aged >50 years. We retrospectively calculated the Kidney Donor Risk Index (KDRI) for each donor and we divided the population according to the KDRI (-, if KDRI ≤ median; +, if KDRI > median) and the histological score (HS, -, if HS ≤ 3; +, if HS > 3) in 4 groups: KDRI-HS- (low KDRI and HS), KDRI-HS+ (low KDRI and high HS), KDRI+HS-(high KDRI and low HS) and KDRI+HS+ (high KDRI and HS). We compared graft function between groups at 2 years and Cox regression analysis was performed to assess the risk for end stage renal disease (ESRD) between groups.

Results

Overall, median KDRI was 1.44 (1.25-1.65), while mean total HS was 3.04±1.62. Median follow-up was 51.9 (26.4 – 99.4) months. Graft function at 2 years was significantly worse in groups with high KDRI (KDRI+HS- and KDRI+HS+) compared to those with low KDRI (p<0.001), while no differences were found according to the HS. By contrast, the best ROC curve in predicting the development of ESRD is for the model that included both KDRI and histological score (AUC 0.81, 95%CI 0.708-0.914, p<0.001). A Cox model adjusted for recipient age, gender, acute rejection, DGF and chronic allograft dysfunction, patients with high KDRI and high HS are more likely to develop ESRD compared to the other groups (OR 5.6, 95%CI 1.3 to 24.5, p=0.02)(Figure 1).

Conclusion

Patients with high KDRI and HS have worse outcome compared to patients with high KDRI but better histology. The integration of histology to clinical score may improve the assessment of the risk for graft failure in patients receiving organs from marginal donors.
P1630IS THERE ALWAYS A SURVIVAL BENEFIT WITH KIDNEY TRANSPLANTATION? RESULTS FROM A BELGIAN COHORT
Authors: Hellemans Rachel , Kramer Anneke , De Meester Johan , Kuypers Dirk , Jadoul Michel , Van Biesen Wim , Le Moine Alain , Krzesinski Jean-Marie , Wissing Karl Martin , Luyckx Kim , Van Meel Marieke , De Vries Erwin , Tieken Ineke , Vogelaar Serge , Samuel Undine , Abramowicz Daniel , Stel Vianda , Jager Kitty J
Published: June 2020

Background and Aims

Older studies have shown a survival benefit with kidney transplantation compared to dialysis, even for patients older than 60 years. However, due to important evolutions such as older recipient age and the use of less-than-optimal quality donors, it is unclear if the survival benefit with transplantation still holds true nowadays.

Method

Patient survival was analyzed for 3808 Belgian patients waitlisted for a first deceased donor kidney transplant between 2000 to 2012. Patients were divided into age categories (20-44y, 45-64y, ≥65y). Primary outcome was the comparison of mortality during median waiting time plus 3 years follow-up, either after transplantation or when remaining on dialysis. Outcomes were analyzed separately for those receiving a standard criteria donor (SCD) or an expanded criteria donor (ECD) transplant. The survival analyses were adjusted for age, sex and primary renal disease.

Results

Among patients ≥ 65 years old, only SCD transplantation provided a significant survival benefit compared to dialysis: mortality was 16.3 % (95 % CI: 13.2–19.9 %) with SCD transplantation, 20.5 % (16.1–24.6 %) with ECD transplantation, and 24.6 % (19.5–29.5 %) when remaining on dialysis. Relative mortality risk was increased in the first months after transplantation compared to dialysis, with equal risk levels being reached earlier for SCD than ECD transplantations in all age groups.

Conclusion

This study suggests that older patients have a survival benefit with SCD transplantation versus dialysis, but the survival benefit with ECD transplantation versus dialysis may be small or non-existent.